Therapeutic effect of hydrocortisone combined with vitamin C and vitamin B1 on patients with sepsis: a Meta-analysis / 中华危重病急救医学

Objective:To systematically evaluate the effect of hydrocortisone combined with vitamin C and vitamin B1 on the efficacy of patients with sepsis or septic shock.Methods:Databases including CNKI, Sino Med, VIP, Wanfang, PubMed, the Cochrane Library, and Embase were searched from inception to January 2021 for the randomized controlled trial (RCT) about hydrocortisone combined with vitamin C and vitamin B1 to treat sepsis or septic shock. The experimental group was given intravenous injection of hydrocortisone, vitamin B1 and vitamin C based on conventional treatment; the control group was given conventional treatment or placebo/hydrocortisone/hydrocortisone+vitamin B1 based on conventional treatment. Outcome indicators included sequential organ failure assessment (SOFA), mortality, the duration of vasoactive drugs, new acute kidney injury (AKI) patients, length of stay in intensive care unit (ICU) and in hospital. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. RevMan 5.3 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 6 articles involving 816 patients were included, with 411 patients in the experimental group and 405 patients in the control group. The Meta-analysis results showed that the duration of vasoactive drugs in the experimental group was significantly shorter than that in the control group [mean difference ( MD) = -24.02, 95% confidence interval (95% CI) was -32.36 to -15.68, P < 0.000 01]. However, there were no significant differences in SOFA, mortality, new AKI patients, the length of ICU stay and hospital stay between the two groups [SOFA: MD = -0.14, 95% CI was -1.15 to 0.87, P = 0.79; mortality: relative risk ( RR) = 0.99, 95% CI was 0.81 to 1.21, P = 0.92; new AKI patients: RR = 1.10, 95% CI was 0.42 to 2.87, P = 0.84; length of ICU stay: MD = 1.33, 95% CI was -2.22 to 4.89, P = 0.46; length of hospital stay: MD = 1.02, 95% CI was -0.66 to 2.69, P = 0.23]. The funnel plot showed that most of the points were symmetrical and showed an inverted funnel shape, suggesting that the publication bias among the studies was small. There was no significant publication bias on this Meta-analysis. Conclusions:Hydrocortisone combined with vitamin C and vitamin B1 can shorten the duration of vasoactive drugs in patients with sepsis or septic shock, but it cannot effectively reduce the SOFA score, mortality, new AKI patients, length of stay in ICU and in hospital. Limited by the number and quality of the included studies, further large-scale, multi-center, blinded, RCT are still needed for verification.

Effects of 37 ℃ volume resuscitation on coagulation function and blood lactic acid in neonates with septic shock / 中华危重病急救医学

Objective To investigate the effect of volume resuscitation with normal saline (NS) at 37 ℃ on the coagulation function and microcirculation of neonates with septic shock. Methods Children with septic shock admitted to neonatal intensive care unit (NICU) of the First Affiliated Hospital of Gannan Medical University were enrolled. Twenty-four newborns with septic shock were divided into two groups by random number table method (12 in each group), and were resuscitated with 10 mL/kg at 25 ℃ NS and 37 ℃ NS respectively on the basis of routine treatment. FactorⅡ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ, and prothrombin time (PT), thrombin Time (TT), fibrinogen (FIB), activated partial thromboplastin time (APTT), D-Dimer (DD), lactic acid (Lac) were detected before treatment and 6 hours and 12 hours after treatment. Results The levels of coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ were not significantly changed before and after treatment in the two groups, and there was no significant difference between the two groups. After treatment, PT and APTT in both groups were gradually shortened, DD and Lac were gradually decreased, FIB were gradually increased, while TT had no significant change. Among them, PT, APTT, DD and Lac at 6 hours after treatment in 37 ℃NS group were significantly lower than those before treatment [PT (s): 14.07±1.02 vs. 17.08±1.54, APTT (s):54.83±12.39 vs. 69.17±16.36, DD (mg/L): 2.40±0.63 vs. 4.18±0.88, Lac (mmol/L): 2.84±0.82 vs. 5.98±1.17, all P < 0.05]; DD and Lac at 6 hours after treatment in 25 ℃ NS group were significantly lower than those before treatment [DD (mg/L): 3.13±0.84 vs. 4.16±1.04, Lac (mmol/L): 4.83±0.64 vs. 5.69±0.74, both P < 0.05], and PT at 12 hours after treatment was significantly shorter than that before treatment (s: 14.63±1.14 vs. 16.48±1.61, P < 0.01); FIB in both 25 ℃ NS group and 37 ℃ NS group at 12 hours after treatment were significantly higher than those before treatment (g/L: 2.83±0.83 vs. 1.58±0.43, 2.87±0.87 vs. 1.47±0.41, both P < 0.01), but TT had no significant change. The comparison between groups showed that PT, DD and Lac in the 37 ℃ NS group were significantly lower than those in the 25 ℃ NS group at 6 hours after treatment [PT (s): 14.07±1.02 vs. 15.69±1.21, DD (mg/L): 2.40±0.63 vs. 3.13±0.84, Lac (mmol/L): 2.84±0.82 vs. 4.83±0.64, all P < 0.05]; at 12 hours after treatment, PT, APTT and DD in the 37 ℃NS group were significantly lower than those in the 25 ℃ NS group [PT (s): 13.26±0.91 vs. 14.63±1.14, APTT (s):37.08±10.43 vs. 54.75±14.96, DD (mg/L): 1.20±0.59 vs. 2.06±0.69, all P < 0.01], and FIB was significantly higher than that in the 25 ℃ NS group (g/L: 2.87±0.87 vs. 2.83±0.83, P < 0.05). Conclusion Volume resuscitation at 37 ℃ can improve the coagulation function and microcirculation of newborns with septic shock.

Analysis of corticosteroids combined with sequential therapy of Chinese Guishao Dihuang pill and Yupingfeng granules on 50 cases with yin deficiency of liver and kidney and nephrotic syndrome in children / 中国中西医结合急救杂志

Objective To explore the clinical effect of corticosteroids combined with Chinese medicine sequential therapy of Guishao Dihuang pill and Yupingfeng granules on children nephrotic syndrome (NS) with yin deficiency of liver and kidney.Methods Fifty patients (the loss of children during the course of treatment were not included in the statistical analysis) with definitely diagnosed NS accompanied by yin deficiency of the liver and kidney admitted to the First Affiliated Hospital of Gannan Medical University from January 2012 to June 2016 were enrolled,and they were divided into control group and observation group by random number table,25 cases in each group.Conventional treatment of western medicine and long-term treatment of corticosteroids were given to the two groups.In addition,sequential therapy of Guishao Dihuang pills and Yupingfeng granules was given to the observation group on the bases of conventional treatment.The changes of platelet aggregation rate (PAT),cholesterol,cortisol,T cell subsets CD3,CD4,CD4/CD8 were observed before and after treatment for 8 weeks and 6 months,then the clinical efficacy and infection,etc.complications were compared between the two groups.Results There were no statistical significant differences in cholesterol,cortisol and curative effect compared between the two groups before treatment and after treatment for 8 weeks and 6 months (all P ＞ 0.05).Mter treatment for 8 weeks and 6 months,the PAT,cholesterol,cortisol of two groups were significantly decreased compared with those before treatment,while CD3,CD4 were obviously higher than those before treatment,and the degrees of changes of PAT,CD3,CD4 in the observation group were more remarkable than those of the control group [PAT:treatment after 8 weeks was (63.01 ± 6.99)％ vs.(66.62 ± 4.65)％,treatment after 6 months was (51.42 ± 7.74)％ vs.(57.01 ± 6.77)％,CD3:treatment after 8 weeks was 0.56 ± 0.06 vs.0.52± 0.06,treatment after 6 months was 0.61 ± 0.05 vs.0.58 ± 0.03,CD4:treatment after 8 weeks was 0.33 ± 0.06 vs.0.30 ± 0.05,treatment after 6 months was 0.39 ± 0.05 vs.0.33 ± 0.06,all P ＜ 0.05].CD4/CD8 ratio was significantly higher in observation group after treatment for 8 weeks and 6 months than those before therapy (1.68 ± 0.76,1.82 ± 0.95 vs.1.16 ± 0.67,both P ＜ 0.05);the number of patients with infection in observation group was obviously lower than that of the control group (86 cases vs.175 cases,P ＜ 0.05).Conclusions The therapeutic effect of corticosteroids combined with Chinese medicine sequential therapy of Guishao Dihuang pills and Yupingfeng granules for treatment of children NS with yin deficiency of the liver and kidney is better than that of using western medicine therapy alone,as the combined sequential therapy has good effects on reduction of infection,anti-thrombosis and elevation of immunity.

Effect of bone marrow stromal cell and its supernatant on expression of synaptophysin in hippocampal dentate gyrus from rats with hypoxic-ischemic brain damage and its mechanism / 实用医学杂志

Objective To analyze the expression of synaptophysin (SY) in hippocampal dentate gyrus of rats with hypoxic-ischemic brain damage(HIBD) after the injection of bone marrow stromal cells(BMSCs) and its supernatant into the lateral ventricle and to explore the mechanism of potential effects. Methods Eighty 7-day-old sprague-dawley(SD) rats were randomly divided into sham group, control group, cell group and supernatant group, with 20 rats in each group. The HIBD model was established via the ligation of left carotid arteries followed by 2-hour hypoxia. One week later, control group was injected with 0.01 mol/L PBS via the left ventricle. Meanwhile, cell and supernatant group were injected with BMSCs and supernatant harvested from BMSC culture, respectively, via the same route. For spam group, the left carotid arteries were separated but not ligated, and no hypoxia treatment was imposed on this group. They also received 0.01mol/L PBS injection one week post surgery. After 8 weeks, the expression of SY in the dentate gyrus of rats was measured. Results Compared with sham group, model group showed significantly lower IOD (integral optical density) of SY positive material in the dentate gyrus(P 0.05). Conclusions BMSCs and supernatant injected via the lateral cerebral ventricle can increase SY expression in the hippocampal dentate gyrus of HIBD rats and promote synapse formation. The mechanism of this effect may be related to cytokine secretion by BMSCs which promotes synapse formation.

Effects of bone marrow mesenchymal stem cells supernatant on hippocampal GFAP expression and learning and memory in rats with neonatal hypoxic ischemic brain damage / 中华行为医学与脑科学杂志

Objective To analyze the expression of glial fibrillary acidic protein(GFAP) in hippocampal of rats with hypoxic-ischemic brain damage(HIBD) after injection of bone marrow stromal cells(BMSCs) supernatant into the lateral ventricle of the neonate rats,assess the ability of learning and memory,and explore the mechanism.Methods 7-day-old SD rats were randomly divided into sham operation group,model group,cells and supernatant group,with 20 rats in each group.The HIBD model was established via the ligation of left carotid arteries followed by 2-hour hypoxia.One week later,rats in control group were injected with 0.01 mol/L PBS 2 μl via the left ventricle.Meanwhile,the cell and the supernatant groups were injected with BMSCs and supernatant harvested from BMSC culture,respectively,via the same route.In the sham operation group,the left carotid arteries were separated but not ligated,and no hypoxia treatment was imposed on this group.They also received 0.01 mol/L PBS injection 2 μl per weak post surgery.8 weeks later,Morris water maze test was performed to assess the learning and memory,and the expression of GFAP in the dentate gyrus of rats was measured by immunohistochemistry.Results Morris water maze showed that the searching time of the probe trail(T1:(15.40±2.80) s) and reversal probe trail (T2:(16.45± 1.16) s) of the model group was shorter than that of the sham operation group (T1:(19.96±2.57) s,T2:(2:25.32±2.54)s,P＜0.05),while the searching time of the cell group(T1:(17.54± 1.80)s,T2:(18.99± 1.47) s) and supernatant group (T1:(17.40±2.37) s,T2:(17.96± 1.09) s) was prolonged compared with that of the model group (P＜0.05).No significant difference between the cell group and the supernatant group (P＞0.05).The integral optical density (IOD) value of GFAP positive cells was higher in the model group than that in the sham operation group(15.26±1.49 vs 12.82±2.56,P＜0.05),while the IOD of cell group(18.13±1.97) and that of the supernatant group(17.38± 1.64) were higher than that of the model group (P＜0.05).However,there was no significant difference between the cell group and the supernatant group (9＞0.05).Conclusion BMSC supernatant injected through lateral ventricle can improve the HIBD rats' abilities of learning and memory.The mechanism might be that MSCs secrete some cytokines to promote central nervous system repair.

Global gene expression responses to Iodine-125 radiation in three human gastric cancer cell lines / 中华外科杂志

<p><b>OBJECTIVE</b>To study genome-wide gene expression changes in gastric cancer cells after iodine-125 ¹²⁵(I) particle irradiation.</p><p><b>METHODS</b>¹²⁵I particles were used to irradiate three gastric cancer cell lines of various differentiation levels:high (BGC-823) , medium (AGS) and low (NCI-N87) .Whole-genome gene expression was investigated with microarray. The gene expression in iodine-125 irradiated and untreated cancer cells was compared, and the genes with transcript levels altered for at least 2 folds (P < 0.05) were selected. The change in gene expression levels was verified by using quantitative real-time (qRT) -PCR.</p><p><b>RESULTS</b>The three gastric cancer cell lines received the same dose rate of ¹²⁵I particle irradiation. Cluster analysis showed that the Gene Ontology (GO) categories did not change in the three cell lines, but changes in gene expression levels were evident for many genes. After ¹²⁵I particle irradiate NCI-N87 cells, 895 genes were up-regulated, 786 genes were down-regulated; AGS was irradiated by ¹²⁵I seed, there were 124 genes upregulated, 161 genes were down-regulated; BGC-823 cells were treated by ¹²⁵I seed irradiation, 2 412 genes upregulated, 3 243 downregulated genes. After ionizing radiation can cause very complex transcriptional regulation changes, KEGG pathway analysis shows that these differentially expressed genes overlap in a particular cell pathway. Four genes, TRAF3IP2-AS1, SDC1, RABL2B and NOM, were found having at least 2-fold difference in expression (P < 0.05) , and the gene expression alteration was confirmed by qRT-PCR.</p><p><b>CONCLUSIONS</b>¹²⁵I particle irradiation caused gene expression changes in gastric cancer cells. The expressions of TRAF3IP2-AS1, SDC1, RABL2B and NOM are altered significantly in all three cell lines studied, indicating that these genes may play an important role in the ¹²⁵I seed treatment of gastric cancer. These genes could be potential targets for developing anti-cancer drugs in the future.</p>

Effect of Bone Marrow Stromal Cells Transplantation on Synapse Formation in Dentate Gyrus and Memory in Rats with Ischemic Brain Injury / 中国康复理论与实践

Objective To observe the synapse formation in hippocampal dentate gyrus, and the memory ability after transplanting bone marrow stromal cells (BMSCs) into lateral ventricle of ischemic brain injury rats. Methods BMSCs from femur of a Sprague-Dawley rat were cultured for 3 generations in vitro. 60 newborn Sprague-Dawley rats were divided into sham group (n=20), model group (n=20) and BMSCs group (n=20). The latter 2 groups were ligated the left common carotid artery, and the BMSCs group were injected BMSCs into the lateral ventricle 7 days after ligation. They were tested with Morris's water maze 8 weeks later, and then, the brains were immunohistochemi-cal staining to detect synaptophysin (SY). Results The time of probe trial of acquisition phase (T1) and reveral phase (T2) decreased in the model group compared with the sham group (P<0.05), and increased in the BMSCs group compared with the model group (P<0.05). The in-tegral optical density (IOD) of SY positive cells decreased in the model group compared with the sham group (P<0.05), and increased in the BMSCs group compared with the model group (P<0.05). Conclusion BMSCs implantation through lateral ventricle can improve the learn-ing and memory ability of rats, which may associated with the synapse formation in dentate gyrus.

The effectiveness and safety of 125I seed implantation for treatment of gastric cancer / 中华核医学与分子影像杂志

Objective To explore the effectiveness of 125I seed implantation for gastric cancer and to determine whether the therapy could increase the survival rate.Methods Seventy-six gastric cancer patients in stage Ⅱ or Ⅲ were involved and randomly divided into treatment group (n =42) and control group (n =34)by simple random sampling method.The patients in the control group underwent D2 or D3 surgery and the patients in treatment group underwent D2 or D3 surgery plus interstitial implantation of 125I seeds.All patients signed the informed consents.Treatment results were evaluated as CR,PR,NC and PD.CR and PR were considered as effective and the effective rate was calculated.All patients were followed up and the three-or five-year survival rate was calculated,the complications were examined.x2 test was used to compare the significant difference between the two groups.Results The total effective rate in control group was 50.00％ (17/34),lower than that of treatment group (73.81％,31/42; x2 =4.578,P＜0.05).In the treatment group,the three-year and five-year survival rates were 61.90％(26/42) and 42.86％(18/42) respectively,and the corresponding rates in the control group were 11.76％(4/34) and 0(0/34) respectively (x2=19.771,19.094,both P＜0.001).Both of the two groups had few severe side effects.Conclusion Radical surgery plus 1~Iseed implantation is effective and safe for the treatment of stage Ⅱ or Ⅲ gastric cancer and can further improvelong-term survival.

Endoscopic thyroidectomy in 68 cases / 中华内分泌外科杂志

Objective To compare the clinical therapeutic effects of thyroid endoscopic surgery and traditional open surgery in treatment of thyroid diseases.Methods Data of 136 patients undergoing thyroid surgery from May.2011 to May.2012 in the Second People's Hospital of Yunnan Province were collected.They were randomly divided into 2 groups:the observation group (n =68) and the control group (n =68).The observation group were treated with endoscopic thyroid surgery and the control group with the traditional surgery.Clinical data of the 2 groups such as operation time,intraoperative blood loss,postoperative drainage volume,postoperative serum interleukin 2 (IL-2),C reaction protein(CRP),TNF-αexpression level,postoperative complications,postoperative hospital stay and so on were collected and compared.Results The difference had no statistical significance between the 2 groups in the operation time,intraoperative blood loss,postoperative drainage volume,postoperative serum IL-2,CRP,TNF-αexpression levels,and postoperative complications (P ＞ 0.05).However,the observation group had superiority in the postoperative hospital stay,neck discomfort and the acceptability than the control group.The difference had statistical significance (P ＜ 0.05).Conclusions Endoscopic thyroid surgery is safe and reliable.Compared with traditional open surgery,it has better cosmetic effects and less trauma.

Injury Mechanism of Vascular Endothelial Cells in Atherosclerosis / 中国普外基础与临床杂志

Objective To summarize the progress on the injury mechanism of vascular endothelial cells in atherosclerosis.Methods The latest progress was reviewed in recent literatures.Results All kinds of etiological factors have activated NF kappa B and cytokines in the development of atherosclerosis, which lead to expression of cell adhesive molecules and adhesion of monocytes to vascular endothelial cells.A variety of inflammatory mediums are released, which can directly damage endothelial cells.Besides, the inflammatory mediums make monocytes and neutrophils attach to endothelial cells by immune mechanisms, which injure the endothelial cells more severely. Meanwhile the damaged membrance structure leads to the production of AECA which activates the complementary system. Then the vascular endothelial cell injury is aggravated and the development of atherosclerosis accelerated. Conclusion It is very important to recognize the injury mechanism of vascular endothelial cells in the development of atherosclerosis for prevention and treatment of atherosclerosis.

Clinical application on iodine-125 seeds interstitial brachytherapy for the cancer of pancreas / 临床外科杂志

Objective To explore the clinical effects of 125 I seeds interstitial brachytherapy in treatment of the cancer of pancreas.Methods 12 patients with pancreatic cancer underwent performed using 125 I intraoperative permanent implantation to tumor bed and regional lymph nodes.Postoperative 3～7 days WBC count and immuoassay were detected after one week,film X-ray was taken to observe the distribution of 125 I seeds.Result 12 patients average survived 9.66-month,and one survive 25-months.No patient present severes complications .Conclusions 125 I seeds interstitialbrachytherapy for the malignant tumor of pancreas is simple,safe and effective,and it is one of ideal methods to treat cancer.

Changes of SCD_(14)、TNF-?、E-SLT and IL-10 level in the process of infection / 中国普通外科杂志

Objective To investigate the changes of SCD 14, TNF-?, E-SLT and IL-10 level in the process of infection.Methods Serum E-SLT, IL-10, SCD 14 and TNF-? level was measured in 37 patients of abdominal trauma, and in model rabbits with endotoxemia.Results Serum level of SCD 14,TNF-?,E-SLT and IL-10 on the 1st to 3rd day post-op increased significantly in patients suffering from post-op infection 〔(1.61?0.47)??g/ml, (28.63?8.29)?pg/ml,(153.6?48.9)?ng/ml and (38.21?10.87)?pg/ml, compared with control, all P

Effects of HIF-1? mRNA overexpression transferred by recombinant adeno-associated virus on novoendotheliasis of vascular endothelial cell in the venous autografts / 中国普通外科杂志

Objective To explore the effects of overexpression of hypoxia inducible factor 1? (HIF 1?) mRNA on vascular endothelial growth factor (VEGF) and novoendotheliasis in venous autografts Methods Wistar rats were randomly divided into two groups with 28 rats in each group A rat experimental model of autogenous vein graft was established by transplanting the right external jugular vein into between the interrupted right common carotid artery The transplanted vein in the experimental group was first immersed into a solution containing recombinant adeno associated virus (rAAV) HIF 1? for 45 minutes Vein grafts and blood simples were taken at 7 or 14 days after transplantation RT PCR, ELISA, immunohistochemistry were used to detected HIF 1? mRNA and VEGF expression Results HIF 1? mRNA and VEGF protein remarkably increased in experimental group, and serum level of E selectin significantly decraesed at day 14 The novoendotheliasis and myo endothelium junction in vein grafts were remodeled at day 14 in the experimental group Conclusion Re establishment of the structure and function of the autograft vein graft endothelium was accelerated by overexpressed HIF 1? mRNA