Two cases of Vibrio vulnificus primary sepsis / 中华烧伤杂志

This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.

Significance of early lymphocyte-platelets ratio on the prognosis of patients with extensive burns / 中华烧伤杂志

Objective: To analyze the changing trend and characteristics of lymphocyte-platelets ratio (LPR) of early stage in patients with extensive burns, and to explore the prognostic significance of LPR. Methods: A retrospective case series study was conducted. From January 2008 to December 2018, 244 patients with extensive burns were admitted to the First Affiliated Hospital of Naval Medical University, including 181 males and 63 females, aged (44±16) years. The total burned area of patients was 60.0% (42.0%, 85.0%) total body surface area. Platelet and lymphocyte test results of patients were collected on the 1st, 2nd and 3rd day after admission, and LPR of patients was calculated to analyze the changing trend of the three days after admission. Univariate and multivariate logistic regression analysis were conducted to investigate the risk factors or independent risk factors for death of patients, including age, sex, total burn area, area of full-thickness burns and above, inhalation injury, and LPR. According to the 1st day's LPR after admission of patients, the receiver operating characteristic (ROC) curve predicting death of patients was drawn to find the optimal value of LPR. Patients were divided into high LPR group (n=136) and low LPR group (n=108) based on the optimal value of LPR, and the clinical data of total burn area, area of full-thickness burns and above, inhalation injury, tracheotomy, offline time of patients within 28 days, and mortality in the 2 groups were compared. The surviving curve of patients was drawn by Kaplan-Meier method to predict the difference of the 90-day survival rate between the two groups of patients. Data were statistically analyzed with Student's t test, Mann-Whitney U test, and chi-square test. Results: Within 3 days of admission, the LPR of patients showed a time-dependent upward trend. LPR of patients on the 2nd and 3rd day after admission was 8.6 (5.3, 14.4) and 8.6 (4.9, 13.7), respectively, which were significantly higher than the 1st day's 6.3 (4.2, 9.8), with Z values of -4.25 and -3.43, respectively, P<0.01. Univariate logistic regression analysis showed that age, total burn area, area of full-thickness burns and above, inhalation injury, and LPR were all risk factors for death of patients (with odds ratios of 1.03, 1.73, 1.31, 4.74, and 3.11, respectively, 95% confidence intervals of 1.01-1.06, 1.40-2.13, 1.21-1.42, 1.62-13.86, and 1.41-6.88, respectively, P<0.01). Multivariate logistic regression analysis showed that age, area of full-thickness burns and above, and LPR were independent risk factors for death of patients (with odds ratios of 1.06, 1.36, and 2.85, respectively, 95% confidence intervals of 1.03-1.09, 1.19-1.55, 1.02-7.97, P<0.05 or P<0.01). The area under ROC curve of the 1st day's LPR, predicting death of patients, was 0.61 (with 95% confidence interval of 0.51-0.71, P<0.05), and the optimal predicted value was 5.8 with corresponding sensitivity of 77% and specificity of 52% respectively. The total burn area, area of full-thickness burns and above, rates of incidence of inhalation injury, tracheotomy, and mortality of patients in high LPR group were significantly higher than those in low LPR group (with Z values of -3.06 and -3.19, χ2 values of 5.42, 11.64, and 8.45, respectively, P<0.05 or P<0.01). The offline time of patients within 28 days in high LPR group was significantly shorter than that in low LPR group (Z=-2.98, P<0.01). Kaplan-Meier survival analysis showed that the 90-day survival rate of admission of patients in low LPR group was significantly higher than that of patients in high LPR group (χ2=8.24, P<0.01). Conclusions: The early LPR of patients with extensive burns showed a time-dependent upward trend. The LPR on the first day after admission that is closely correlated with total burn area, area of full-thickness and deeper burns, inhalation injury, tracheotomy, and mortality of patients, is an independent risk factor for the prognosis of patients with extensive burns. The first day's LPR after admission is significantly correlated with the 90-day survival rate of patients, which can be used as an evaluation index for the severity of extensive burns.

Research advances on the application of carbon dots in wound treatment / 中华烧伤杂志

Chronic and infectious wound healing has always been an issue of concern in clinical and scientific research, in which bacterial infection and oxidative damage are the key factors hindering wound healing. Carbon dots, as a new material, has attracted much attention because of its unique physical and chemical properties and good biological safety. In recent years, the researches on the antibacterial property, antioxidant, and photoluminescence properties of carbon dots are more and more extensive and carbon dots have great potential in the treatment of chronic and infectious wounds. This paper reviews the research progress of carbon dots in three aspects: antibacterial, anti-oxidation and monitoring of wound infection are reviewed, and further discusses its specific mechanism, potential research direction, and application prospect.

Successful salvage treatment of acute graft-versus-host disease after liver transplantation by withdrawal of immunosuppression: a case report

Acute graft-versus-host disease (GVHD) following liver transplantation is a rare but fatal complication. The correct diagnosis and management of GVHD after liver transplantation are still major challenges. Herein, we reported successful salvage treatment of acute GVHD by withdrawal of immunosuppression in a patient who presented with fever, skin rashes, and decreased blood cell counts after liver transplantation. This case highlights the need for awareness of drug-induced liver injury if liver function tests are elevated during treatment, especially in patients taking multiple potentially hepatotoxic drugs, such as broad-spectrum antibiotics. When occurs, an artificial liver support system is a useful tool to provide temporary support of liver function for the patient in the event of drug-induced liver injury.

Association between serum homocysteine and in-hospital death in patients with acute pulmonary embolism / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association between serum homocysteine (Hcy) level and in-hospital death in patients with acute pulmonary embolism.</p><p><b>METHODS</b>A total of 186 acute pulmonary embolism patients [ (66.8 ± 12.7) years, 89 male] hospitalized in our department between June 2008 and June 2011 were included in this prospective study. Patients were divided into high Hcy group (Hcy ≥ 15.2 µmol/L, n = 95) and low Hcy group (Hcy < 15.2 µmol/L, n = 91). Patients were followed-up for 1 year for the incidence rate of early death associated with acute pulmonary embolism. The Cox proportional hazard model was used to analyze the relationship between serum Hcy level and early death in acute pulmonary embolism patients.</p><p><b>RESULTS</b>Patients were hospitalized for 1-37 days [(10 ± 6) days]. In-hospital death rate was 14.5% (27/186) and was significantly higher in high Hcy group than in low Hcy group [25.3% (24/95) vs. 3.3% (3/91) , P = 0.001]. Univariate Cox regression analysis indicated that admission heart rate, oxygen saturation, enlargement of right ventricle, Hcy ≥ 15.2 µmol/L, serum creatinine level, peak TnT level and deep venous thrombosis (P < 0.05) were independent risk factors for in-hospital death. Multivariate Cox regression analysis showed that Hcy ≥ 15.2 µmol/L (HR = 4.10, 95%CI:3.00-4.98, P = 0.017), admission heart rate (HR = 1.10, 95%CI:1.01-1.20, P = 0.031) , deep venous thrombosis (HR = 1.65, 95%CI:1.45-1.76, P = 0.034) and age (HR = 1.10, 95%CI:1.02-1.19, P = 0.010) were independent predictors of in-hospital death for acute pulmonary embolism patients. One-year follow up was finished in 142 patients (89.3%). There were 19 deaths ( 5 due to repeat pulmonary embolism, 4 due to decompensated respiratory and /or cardiac diseases, 6 due to malignant tumors, 2 due to fatal bleeding and 2 due to pneumonia) . Death rate was similar between the two groups during follow up.</p><p><b>CONCLUSION</b>Higher serum homocysteine is an independent for in-hospital death for patients with acute pulmonary embolism.</p>

Advancement in the research of mechanism of endogenous cellular injury in visceral complications as complications after severe burn / 中华烧伤杂志

It is of great importance to know the endogenous mechanism in burn-induced organ injuries, not only for the understanding of pathophysiological processes after burn, but also for guiding the clinical treatment. Recent studies have widened and deepened our scope and understanding of secondary injuries to various organs. However, a unanimous understanding of molecular pathway involved in all burn-induced organ injuries has not been attained. Relatively, the mechanism of endogenous cellular injuries as a result of burn injury could be regarded as a common one to explain the causation of cellular injury, and to guide the prevention and treatment for the burn-induced complications using cytoprotection strategy. This review summarized four aspects of the mechanism of endogenous cellular injuries, including cellular injuries induced by ischemic/hypoxic-oxidative stress, excessive inflammatory factors released by inflammatory cells, immunosuppression caused by suppression of function of adaptive immune cells, and dysfunction of important supportive cells of various organs.

Clinical analysis of 150 patients with idiopathic pulmonary arterial hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the demographic characteristics and clinical features of patients with idiopathic pulmonary arterial hypertension (IPAH) in China.</p><p><b>METHODS</b>Between March 2007 and September 2010, IPAH diagnosis was confirmed by right heart catheterization in 150 adult patients from 31 clinical centers in China. Clinical and hemodynamic data were analyzed and patients were divided into WHO functional class I/II and WHO functional class III/IV group.</p><p><b>RESULTS</b>The mean age of 150 patients were 36 ± 13 years with female patient/male patient ratio of 2:1, and mean BMI was (21.3 ± 3.5) kg/m(2). Fatigue (n = 123, 82.0%) and dyspnea (n = 112, 74.7%) are the most common symptoms. Accentuated pulmonic second sound (P(2)) was detected in 92.0% (n = 138) of patients during physical examination, which was also the most common sign. About 49.0% (n = 73) patients were WHO functional class I/II patients and 46.0% (n = 68) patients were WHO functional class III/IV patients. Six minutes walking distance (6MWD) and Borg dyspnea score was (337 ± 101) m and 2.0 (2.0, 4.0), respectively. Right ventricular hypertrophy was suggested by ECG in 93.1% (n = 140) patients. Right atrial pressure was (10 ± 6) mm Hg, mean pulmonary artery pressure was (61 ± 16) mm Hg, cardiac index was (2.3 ± 0.8) L×min(-1)×m(-2) and pulmonary vascular resistance (1484 ± 699) dyn×s(-1)×cm(-5) in this cohort. 6 MWD (305 m ± 89 m vs. 377 m ± 88 m) was significantly shorter while Borg dyspnea score [3.0 (3.0, 5.0) vs. 2.0 (2.0, 3.0)] was significantly higher in WHO functional class III/IV patients than in WHO functional class I/II patients. Similarly hemodynamic parameters were also worse in WHO functional class III/IV patients than in WHO functional class I/II patients (all P < 0.05).</p><p><b>CONCLUSION</b>Idiopathic pulmonary arterial hypertension patients in this cohort affect mostly young adults, dominated by female gender and lower body mass index. Fatigue and dyspnea are the most common symptoms and accentuated pulmonic second sound (P(2)) is the most common sign. IPAH patients are often displaying severe functional and hemodynamic disturbance at first visit to hospitals. Dyspnea and hemodynamic impairment are related to 6MWD and WHO functional class.</p>

Effect of RhoC on hepatocellular carcinoma cell growth and related molecular mechanisms / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To clarify the role of RhoC in the growth of hepatocellular carcinoma cells and its molecular mechanism, so as to explore the molecular target of tumor cell growth.</p><p><b>METHODS</b>siRNA-RhoC plasmid was constructed and RhoC gene silencing the cell-line of hepatocellular carcinoma was setup. Cell growth was assessed by MTT assay. AgNORs staining was applied to determine cell proliferation. Plate cell clone test was conducted to examine the capacity of cell clone formation. FACS was adopted to measure the course of cell cycle and semi-quantitative RT-PCR was used to determine the expression of cell cycle proteins. In order to further determine the effect of RhoC expression on cell growth, a RhoC over-expression human hepatocellular cell line was setup by PcDNA3-RhoC plasmid transfection.</p><p><b>RESULTS</b>The inhibition rate of RhoC was 82.3%. From the fourth day of cell culture, the growth of cells in RNAi group was significantly slower than that in parental Bel7402 and negative control groups (0.41 ± 0.10 vs. 0.73 ± 0.11 and 0.71 ± 0.07 respectively, P < 0.05). AgNORs staining showed that average cell stained particles in RNAi group was significantly lower than that in parental Bel7402 and negative control(1.23 ± 0.35 vs. 3.47 ± 0.93 and 3.17 ± 0.78, P < 0.01). Plate clone formation test showed that clone formation efficiency in the RNAi group was notably lower than that in the control group [(20.33 ± 5.42)% vs. (70.58 ± 10.10)% and (69.83 ± 14.77)%, respectively, P < 0.01]. Cell cycle analysis by FACS showed that G(0)/G(1) cell percentage in the RNAi group was significantly higher than that in the control group [(73.14 ± 5.93)% vs. (57.05 ± 5.97)% and (52.99 ± 4.80)%, P < 0.05]. Compared with Bel7402 and negative control groups, the expression of following growth associated genes was significantly decreased: cyclin D1(0.45 ± 0.21 vs. 1.25 ± 0.24 and 1.12 ± 0.15, respectively, P < 0.05)and CDK4 (0.55 ± 0.08 vs. 1.18 ± 0.32 and 1.10 ± 0.29, respectively, P < 0.05); the following genes were notably increased: p16(1.07 ± 0.23 vs. 0.36 ± 0.12 and 0.35 ± 0.13, respectively, P < 0.01)and p21(0.42 ± 0.12 vs. 0.17 ± 0.06 and 0.19 ± 0.08, respectively, P < 0.05). RhoC was highly expressed in PcDNA3-RhoC transfected hepatocellular cell line. From the third day on of the cell culture, cell growth in PcDNA3-RhoC group was remarkably higher than that in the HL7702 and PcDNA3 groups (0.83 ± 0.10 vs. 0.54 ± 0.11 and 0.58 ± 0.55, respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>RhoC is the key molecule in promoting hepatocellular cell growth, and is a promising target for tumor cell growth controlling.</p>

The efficacy and safety of bosentan therapy for Chinese patients with idiopathic pulmonary arterial hypertension: an open-label, prospective multicenter study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the efficacy, safety and tolerance of bosentan, a dual endothelin receptor antagonist, in Chinese patients with idiopathic pulmonary arterial hypertension (IPAH).</p><p><b>METHODS</b>Totally 79 IPAH patients (hemodynamic criteria confirmed by right heart catheterization) were included in this open-label, prospective multicenter study. Patients received 62.5 mg of bosentan twice daily for the first 4 weeks, and then up-titrated to 125 mg twice daily for another 12 weeks. The primary end point was the change in exercise capacity showed by six-minute walk distance (6MWD) from baseline to 16 weeks. Secondary end points included the change in World Health Organization (WHO) functional class, Borg dyspnoea scale and systolic pulmonary artery pressure measured by echocardiography.</p><p><b>RESULTS</b>The 6MWD increased from (343.7 ± 93.7) meters at baseline to (397.5 ± 104.4) meters after 16 weeks (P < 0.01), WHO functional class and Borg dyspnoea scale were also significantly improved after 16 weeks therapy compared to baseline levels (all P < 0.01). Furthermore, the systolic pulmonary artery pressure was significantly decreased from (97.8 ± 25.2) mm Hg (1 mm Hg = 0.133 kPa) to (92.8 ± 29.5) mm Hg (P < 0.05) after 16 weeks bosentan treatment. There was no patient withdrawal from this study for safety consideration.</p><p><b>CONCLUSION</b>Bosentan therapy is well tolerated and can improve the exercise capacity and WHO functional class in Chinese IPAH patients.</p>

Effect of mild hypothermia in combination of acupuncture on Bcl-2 and Bax protein expressions of local cerebral ischemia/reperfusion rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe and compare the effects of acupuncture in combination of mild hypothermia therapy on the expressions of Bcl-2 and Bax.</p><p><b>METHODS</b>Fifty rats were randomly divided into 5 groups, i.e., the control group, the model group, the acupuncture group, the mild hypothermia group, and the combination group (acupuncture in combination of mild hypothermia therapy), 10 in each group. Focal cerebral ischemia model was prepared with modified Longa's suture method. The effects of acupuncture, the mild hypothermia, and the acupuncture in combination of mild hypothermia therapy on the expressions of Bcl-2 and Bax were observed. The indices were detected using immunohistochemical assay.</p><p><b>RESULTS</b>Compared with the control group, the expression of Bcl-2 in the model groups significantly decreased (P < 0.01), and the expression of Bax significantly increased (P < 0.01). Compared with the model group, the expression of Bcl-2 in the three treatment groups significantly increased (P < 0.01) and the expression of Bax significantly decreased (P < 0.01). Compared with the acupuncture group and the mild hypothermia group, the expression of Bcl-2 significantly increased and the expression of Bax significantly decreased in the combination group (both P < 0.01). Compared with the mild hypothermia group, increased expression of Bcl-2 and decreased expression of Bax in the acupuncture group were not obvious (P > 0.05). There was insignificant difference in the therapeutic efficacy between the acupuncture group and the mild hypothermia group.</p><p><b>CONCLUSIONS</b>Both acupuncture and the mild hypothermia therapy could increase the expression of Bcl-2 and decrease the expression of Bax, intervene cerebral ischemia, and protect neurons. In the early cerebral ischemia/reperfusion stage, it is necessary to perform acupuncture and mild hypothermia therapy as soon as possible.</p>

Preliminary experience using transthoracic echocardiography guiding percutaneous closure of ruptured right sinus of Valsalva aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the 21st century, minimally invasive treatment is one of the main developmental directions of medical sciences. It is well known that the echocardiography plays an important role during interventional treatments of some structural heart diseases. Because the ruptured right sinus of the Valsalva aneurysm (RRSVA) is a rare disease, there were few reports about percutaneous catheter closure of RRSVA. This study aimed to sum up our experience with transthoracic echocardiography (TTE) during percutaneous catheter closure of RRSVA.</p><p><b>METHODS</b>Five RRSVA cases were treated with percutaneous catheter closure. The whole procedure was guided and monitored by TTE and fluoroscopy. The maximum diameter of the RRSVA was measured by TTE before and after the catheter passed through the rupture site. A duct occluder 2 mm larger than the maximum diameter was chosen. The closure effects were evaluated with TTE and fluoroscopy immediately after the occluding device was deployed. All patients were followed up by TTE for 8 to 30 months.</p><p><b>RESULTS</b>Before the catheter passed through the rupture site the maximum diameter of the RRSVA measured with TTE and aortography were (7.9 ± 2.1) mm and (7.8 ± 1.8) mm. After the catheter passed through the rupture site the maximum diameter measured with TTE was (11.2 ± 3.2) mm, which was significantly larger than before the procedure (P < 0.05). The percutaneous catheter closure was successful in four cases and failed in one. Compared to the aortography the TTE was better at distinguishing residual shunts from aortic valve regurgitation immediately after the occluding device was deployed. There were no complications during 8 to 30 months of follow-up.</p><p><b>CONCLUSION</b>Transthoracic echocardiography can play an important role during percutaneous catheter closure of RRSVA, especially for estimating the size of the RRSVA after the catheter passes through the rupture site, and differentiating residual shunt from aortic valve regurgitation immediately after the occluding device is deployed.</p>

In vivo magnetic resonance imaging tracking of transplanted adipose-derived stem cells labeled with superparamagnetic iron oxide in rat hearts / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility of in vivo magnetic resonance imaging (MRI) tracking of transplanted adipose-derived stem cells (ADSCs) labeled with superparamagnetic iron oxide (SPIO) in rat heart.</p><p><b>METHODS</b>ADSCs were labeled with poly-L-lysine (PLL)-SPIO complexes. Intracellular iron uptake was identified by Prussian blue stain and transmission electromicroscopy. Trypan blue staining was used to test the viability of the labeled cells. In vitro MRI of labeled cells was performed. SPIO-labeled ADSCs were transplanted into normal rat hearts and were in vivo imaged with MRI. Image findings on MRI were correlated with histological findings of the rat hearts.</p><p><b>RESULTS</b>The labeling efficacy of ADSCs with PLL-SPIO was nearly 100%. Light microscopy revealed the SPIO particles were located in the cytoplasm of the ADSCs by Prussian blue staining. Transmission electromicroscopy revealed that the SPIO particles were located in the endosomes in the cytoplasm. There was no significantly deference in viability between labeled and unlabeled groups demonstrated by Trypan blue test (P > 0.05). MRI showed signal loss in gel mixed with labeled cells as compared with the unlabeled cells group and blank group. Signal void on rat hearts were demonstrated on MRI and were well correlated with histological findings where Prussian-blue-stain positive cells presented.</p><p><b>CONCLUSION</b>MRI can be used to in vivo track the transplanted ADSCs labeled with SPIO into rat hearts and facilitate to understand the conditions of the labeled cells in the transplanted areas.</p>

Effect of siRNA targeting c-Myc and VEGF on human colorectal cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the biological behavioral effects of specific siRNA expression plasmids targeted against c-Myc and vascular endothelial growth factor (VEGF) on human colorectal cancer cell line Volo.</p><p><b>METHODS</b>The expression plasmids with small interfering RNA (siRNA) aiming at c-Myc and VEGF were designed and constructed respectively, then transfected into Volo cells by eukaryocyte transfection technique. The protein expressions of c-Myc and VEGF were detected by Western blotting. Cellular proliferation, apoptosis, cycle distribution and invasion character were analyzed by tetrazolium bromide colorimetry (MTT), flow cytometry (FCM), TUNEL assay and matrigel invasion assay respectively.</p><p><b>RESULTS</b>Enzymatic digestion and DNA sequencing confirmed that the c-Myc and VEGF specific siRNA expression plasmids were constructed successfully. After plasmids were transfected into cells, the protein expressions of c-Myc and VEGF were significantly down-regulated respectively as compared with control group (P<0.01). The cellular proliferation inhibitory rates in c-Myc siRNA group, VEGF siRNA group and c-Myc+VEGF group were (59.20+/-5.05)%, (32.31+/-3.48)% and (75.81+/-7.89)% respectively, which were higher than that in control group [(6.80+/-1.45)%] (all P<0.05). The cell apoptosis rate in above 3 groups were (40.50+/-4.37)%, (21.30+/-2.98)% and (62.59+/-9.66)% respectively, which were higher than that in control group [(2.90+/-0.36)%] (all P<0.05). The cell invasion rates in VEGF siRNA group and c-Myc+VEGF siRNA group were (7.34+/-3.65)% and (2.80+/-1.02)%, which were lower than that in control group [(18.57+/-7.46)%] (P<0.05). The effect of c-Myc+VEGF siRNA group was greater.</p><p><b>CONCLUSIONS</b>The specific siRNA efficiently silences the expression of c-Myc and VEGF, subsequently, suppresses the cell proliferation, triggers the cell apoptosis and inhibits the cell invasiveness in these transfected colorectal cancer Volo cells. In addition, the synergism of siRNA-c-Myc and siRNA-VEGF in transfected cells can be found.</p>

The value of spleen sub-pedicle two steps severance with LigaSure in laparoscopic splenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and utility of the methods of spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy.</p><p><b>METHODS</b>The methods and the curative effect of 32 patients with laparoscopic splenectomy performed by the way as mentioned above were summarized and analyzed. 4 males, 28 females, median 36 years (range 16 - 64 years). Mean dimensions of spleens were 17 cm (range 11 - 23 cm). Nineteen patients had idiopathic thrombocytopenia purpura (ITP), 6 hereditary spherocytosis (HS) (5 of them were the same family constellation), 3 hemolytic anemia (HA), 2 spleen injury with haematoma infection, 1 Evan syndrome, 1 leukemia. Peri-splenic ligaments were resected by LigaSure combined with ultrasound scalpel, splenic pedicle was resected by spleen sub-pedicle two steps severance with LigaSure when splenic pedicle were sufficiently free. Splenic pedicle was non-excisional occluded by LigaSure at pancreatic cauda, in the first step and was occluded and resected alongside of the spleen in the second step.</p><p><b>RESULTS</b>All of the 32 cases were completely succeed, the average operating time was 70 min (55 - 130 min), the estimated intraoperative blood loss was 200 ml (50 - 600 ml), no complications such as abdominal haemorrhage, visceral injury, pancreatic leakage and infection were observed. All the patients were healed well, the average hospital stay after an operation was 6 days. The average expense of each patients could save 8050 yuan because Endo-GIA was not used.</p><p><b>CONCLUSIONS</b>Spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy, which shorten the operating persistence time with less hemorrhage is a safe, effective and low-cost minimally invasive surgery in selective cases.</p>

Discussion on the fluid resuscitation and monitoring during burn shock period / 中华烧伤杂志

The index of monitoring burn shock resuscitation includes clinical signs and symptoms, laboratory examinations, hemodynamic variables. In recent years, there exists a tendency that the amount of transfused fluid for burn shock resuscitation is notably increased and complications of some cases, such as abdominal compartment syndrome have been reported. One of the major reasons for excessive fluid resuscitation is to try to normalize hemodynamic parameters with the help of invasive hemodynamic monitoring. Instead of hemodynamic variables, urinary output combined with other traditional variables still should be considered primary criteria of adequate fluid therapy. Specification of the variables of monitoring burn shock resuscitation is also the basis to revise and optimize the fluid resuscitation formula.

Differences of vascular endothelial function between Tibetan and Han nationality populations☆ / 中国组织工程研究

BACKGROUND: Recently, it is thought that endothelial function is a new independent risk factor of atherosclerotic disease. However, the differences in endothelial function between Tibetan and Han nationality populations have not been fully investigated.OBJ ECTIVE: To investigate the differences in endothelial function between Tibetan and Han nationality population.DESIGN: Controlled analysis.SETTING: Department of Cardiology, General Hospital; Department of Cardiology, Tibet General Hospital of Chinese PLA.PARTICIPANTS: Totally 272 Tibetan male subjects, aged (43±9) years, were enrolled in this study to stand for Tibetan nationality populations. All of them were native residents in Lhasa city. And 580 Qinghai-Tibetan railway constructers with Han nationality, aged (42±11) years, were enrolled in this study to stand for Han nationality populations. All of them were male subjects from Sichuan province and lived in Lhasa city for at least 1 year. All the participants received regular physical examination between February and May 2006 in the General Hospital of Tibet Military Area Command of Chinese PLA. All the subjects lived in the same high-altitude area (the altitude of Lhasa is 3 658 m). Informed consents were obtained from all the participants.METHODS: ①Height, body mass, waist circumference, hip circumference, systolic blood pressure(SBP) and diastolic blood pressure (DBP) were measured. Body mass index (BMI) was measured as body mass/height2. ② Measurement of brachial artery flow-mediated dilation (FMD): All the participants, who were in the fasting state, were examined in supine position following 20-minute rest. The room temperature was about 20 ℃. In the right arm, a sphygmomanometer cuff was positioned 5 cm below the antecubital fossa. A 10-MHz transducer (Vivid 7, GE Corporation, USA) was used to image the right brachial artery. After obtaining the baseline imaging, the blood pressure cuff was inflated 50 mm Hg (1 mm Hg=0.133 kPa) above the participant's SBP to occlude the brachial artery for 4 minutes. The brachial artery was then imaged during cuff inflation and 2 minutes after cuff release. After the cuff was released and reactive hyperaemia occurred, that was, flow in the brachial artery increased to accommodate the dilated resistance vessels in the forearm. In order to ensure the reliability of the data, the cuff placement and image record were performed by two designated performers. Computer-assisted analysis software was used to calculate brachial artery diameters. The absolute and relative changes of brachial artery FMD were automatically calculated out with the attached software of Vivid 7 ultrasonic diagnosis instrument. ③Biochemical study: The biochemical parameters were obtained after an overnight fasting for 12 hours. Venous blood was sampled for the measurement of total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol and low-density lipoprotein cholesterol (LDL-C). ④ Analysis of variance was used to evaluate the measurement data. Chi-square statistic was used to compare enumeration data.MAIN OUTCOME MEASURES: Comparison of change in BMI, waist-hip ratio, blood pressure, blood lipid, baseline brachial diameter and brachial diameter between 2 groups.RESULTS: Totally 272 Tibetan nationality populations and 583 Han nationality populations participated in the final analysis. ① Brachial artery FMD: The baseline brachial artery diameter of Tibetan nationality populations was significantly larger than that of Han nationality population [(4.28±0.06) mm vs. (4.03±0.04) mm, t =71.915 6, P ＜0.01]; The absolute and relative changes of brachial artery of Tibetan nationality populations were significantly smaller than those of Han nationality populations, respectively [(0.124±0.005) mm vs. (0.141±0.006) mm; (2.934±0.204)% vs.(3.587±0.152)%, t = 40.582 0,52.173 2, P ＜ 0.01]. ②Physical study results: BMI and waist-hip ratio of Tibetan nationality populations were significantly larger than those of Han nationality populations [(30.1±2.5) kg/m2 vs. (26.5±3.4) kg/m2, 0.92±0.07 vs. 0.88±0.05, t =15.595 1, 9.525 4, P ＜ 0.01]. ③TG and LDL-C levels of Tibetan nationality population were (2.31±1.31) mmol/L and (3.49±0.91) mmol/L, respectively, which were significantly higler than those of Han nationality population [(1.97±1.44) mmol/L and (3.07±0.86) mmol/L, t =3.420 0, 6.522 3, P ＜ 0.01].CONCLUSION: ① Brachial artery FMD of Tibetan nationality population is poorer than that of Han nationality population,I.e. Poor vascular reactivity. ② Tibetan nationality populations have severe abdominal obesity and higher level of blood lipid as compared with Han nationality populations.

Anti-hypoxia and anti-oxidation effects of aminophylline on human with acute high-altitude exposure / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the anti-hypoxia and anti-oxidation effects of aminophylline on human with acute high-altitude exposure.</p><p><b>METHODS</b>Totally 100 young male army members newly recruited from Sichuan province (400 meters above sea level) were enrolled. They were randomly divided into two groups: 50 in aminophylline group (A group) and 50 in control group (C group). A group and C group orally took aminophylline and placebo respectively for 10 days, 7 days before entering Lhasa (3 658 meters above sea level) by air and 3 days after it. Several parameters were measured at three time points: before drug taken, 7 days after drug taken, and 3 days after ascending high altitude. These parameters included serum levels of nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT), hydrogen dioxide (H2O2), lactic acid (LA), as well as arterial oxygen saturation (SO2), arterial oxygen partial pressure (PaO2), and arterial carbon dioxide partial pressure (PaCO2). Statistical analysis was conducted to compare the difference between two groups with Stata 7.0 software system.</p><p><b>RESULTS</b>There were no statistical differences between groups in hypoxia and oxidation indicators before and after drug taken in plain area. Three days after ascending high altitude, the serum levels of SOD, CAT, H2O2, LA, PaCO2 increased in both groups, yet to a much larger degree in C group than A group (P < 0.01); and NO, SO2, PaO2 decreased more markedly in C group (P < 0.05 for NO, P < 0.0001 for SO2 and PaO2).</p><p><b>CONCLUSION</b>Aminophylline has significant anti-hypoxia and anti-oxidation effects at high altitude.</p>

Protective effect of sodium pyruvate on ischemia/reperfusion injury of rats subjected to hemorrhagic shock / 中国应用生理学杂志

<p><b>AIM</b>To study the protective effect of sodium pyruvate on ischemia/reperfusion injury following hemorrhagic shock.</p><p><b>METHODS</b>Rat models of hemorrhagic shock were built up. When the shed blood was infused, the rats were also randomly provided by one of normal saline, glutathione and sodium pyruvate. Rats were killed 3 hours after the reperfusion, the activity of plasma lactate dehydrogenase (LDH) and glutamic-oxaloacetic transaminase (GOT), the level of tissue malondialdehyde (MDA) and the activity of tissue myeloperoxidase (MPO) were detected. Biopsy specimens were obtained to investigate morphological changes of the myocardial, hepatic, lung and renal tissue.</p><p><b>RESULTS</b>The activity of plasma LDH and GOT, the level of MDA of hepatic, lung and renal tissue and the activity of MPO of myocardial, lung and renal tissue decreased remarkably in group given sodium pyruvate compared with group given normal saline, and the effect of group given sodium pyruvate was more remarkable than group given glutathione.</p><p><b>CONCLUSION</b>These data support the view that sodium pyruvate shows protective effect on ischemia/reperfusion injury following hemorrhagic shock. It is possibly relevant to scavenging of oxygen free radicals, reduction of neutrophil, and anti-inflammatory response.</p>

The use of transesophageal echo-Doppler device in the management of burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the validity of transesophageal echo-Doppler technique for hemodynamic monitoring of patients with extensive burns during shock stage to provide guidance for fluid resuscitation.</p><p><b>METHODS</b>Mongrel dogs were inflicted with 50% TBSA full-thickness burns. Cardiac output (CO) were determined by Swan-Ganz catheter, and other hemodynamic indices by transesophageal echo-Doppler device, including aortic blood flow (ABF), stroke volume (SVa), left ventricle ejection time (LVET), peak velocity (PV), max acceleration (max ACC), total systemic vascular resistance (TSVR) were collected before and after burns. Hemodynamic indices of ten patients with extensive burns were collected by transesophageal echo-Doppler device with in 24 hours after the injury.</p><p><b>RESULTS</b>Both CO and ABF showed continuous decrease after burns, and there was positive correlation between them (r = 0.90, P < 0.01). The myocardiac contractibility (ACC, PV) and the preload of the left ventricle (LVET) were also decreased continuously after bums,but the postburn afterload (TSVR) were obviously increased. For the patients with conventional therapy, the hemodynamic state of low cardiac output and high peripheral resistance during early period was converted to high cardiac output and low peripheral resistance 24 hours after injury.</p><p><b>CONCLUSION</b>Transesophageal echo-Doppler technique is useful in monitoring hemodynamic in patients with extensive burn, and it is non-invasive, real-time, synchronized and rapid, and it can provide complete profile of hemodynamic data.</p>

Risk factors and the management of anastomotic leakage after anus-preserving operation for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and management of anastomotic leakage after radical resection for rectal cancer and preservation of anal sphincter.</p><p><b>METHODS</b>The clinical data of 190 rectal cancer patients, undergone sphincter preserving procedures from Jan. 2004 to Jan. 2006, were analyzed retrospectively.</p><p><b>RESULTS</b>The incidence of anastomotic leakage among the 190 rectal cancer patients was 7.9% (15 patients). The leakage occurred from 2 to 17 days postoperatively and the average time of appearance was 5.8 days. Thirteen cases of anastomotic leakage were healed by conservative therapy. The treatment included nutritional support, catheter drainage of abdominal abscesses and the use of antibiotics. Healing time ranged from 10 to 60 days and the mean time was 21.8 days. The other 2 patients were healed by abdominal perineal resection and loop colostomy of transverse colon respectively. The complication of anastomotic leakage was associated with age (10.2% in older than 60 years versus 3.2% in younger than 60 years), physical status (20.7% in poor condition patients versus 5.6% in good condition patients), bowel obstruction (19.1% with obstruction versus 6.5% without obstruction), anastomotic procedure (12.2% in Parks' anastomosis versus 6.7% Dixon anastomosis), anastomotic location (9.2% for outside of peritoneal anastomosis versus 2.7 for inside of peritoneal anastomosis). The rates of anastomotic leakage in staple-line manual reinforce group and postoperative anorectal drainage group were significantly decreased than those in control groups (1.9% versus 11.4% and 2.9% versus 10.7%)(P<0.05).</p><p><b>CONCLUSIONS</b>Elderly patients, poor general condition, preoperative tumor obstruction, outside of peritoneal anastomosis are independent risk factors for the development of anastomotic leakage. Manual staple-line reinforce after stapled anastomosis and postoperative placement of drainage in rectum may be effective in decreasing the rate of anastomotic failure. Early and active conservative approach should be considered as the main treatment of anastomotic leakage.</p>