The preliminary study of extracorporeal carbon dioxide removal in acute respiratory distress syndrome for a pediatric patient / 中国小儿急救医学

Objective:Extracorporeal carbon dioxide removal(ECCO 2R) is a technique that aims to decarboxylate the blood and thus to correct hypercapnia and respiratory acidosis in acute respiratory failure, but is rarely used in children.We successfully completed the ECCO 2R treatment for a pediatric case with adenovirus pneumonia, severe acute respiratory distress syndrome(ARDS) and hypercapnia in PICU, which provided clinical references for the use of ECCO 2R in acute respiratory failure for children. Methods:A patient with adenovirus pneumonia and severe ARDS was successfully treated with ECCO 2R-continuous renal replacement therapy(CRRT)combined system after weaning from extracorporeal membrane oxygenation(ECMO). We reported the treatment process, ECCO 2R treatment effect and side effects, so as to provide clinical reference for ECCO 2R treatment of children with ARDS. Results:One-year and four-month-old boy was treated with mechanical ventilation and venous-arterial ECMO due to adenovirus pneumonia and severe ARDS.After ECMO treatment for 25 days, he developed severe hypercapnia after weaning from ECMO.ECCO 2R was initiated.The pH value increased by 11.2%(from 7.222 to 7.303) 1 hour after ECCO 2R treatment, partial pressure of blood carbon dioxide(PCO 2)decreased by 29.1%(from 72.6 mmHg to 51.5 mmHg, 1 mmHg=0.133 kPa) and the average airway pressure of high-frequency ventilation decreased by 5 cmH 2O(from 20 cmH 2O to 15 cmH 2O, 1 cmH 2O=0.098 kPa) after 6 hours of ECCO 2R.The CO 2 removal rate of ECCO 2R system was 29.1 mL/min.It was stopped because of ECCO 2R-membrane clotting after 72 h. There was no increase of PCO 2.Extubation was successfully after undergoing invasive mechanical ventilation for 39 days and with noninvasive ventilation for 5 days.The boy was hospitalized in PICU for 54 days, improved and discharged from the hospital.Followed up for 2 years after discharge, the growth and development were good, but the strenuous exercise endurance was still poor. Conclusion:ECCO 2R is effective in improving gas exchange, reducing PCO 2 and lowering ventilator pressure in children with ARDS and hypercapnia, which allow more protective ventilation.ECCO 2R provide transitional treatment for ECMO weaning and provide meaningful clinical reference for the use of ECCO 2R as part of respiratory support in children with respiratory failure.

Screening of mRNA expression differences of PI3K/Akt/eNOS in the aortic tissue of rats exposed to sodium fluoride based on mRNA sequencing / 中华地方病学杂志

Objective:To explore the effect of fluoride exposure on the gene expression of phosphatidylinositol-3-kinase/protein kinase B/endothelial nitric oxide synthase (PI3K/Akt/eNOS) in rat aortic tissue, and to provide a theoretical basis for studying the mechanism of cardiovascular injury caused by endemic fluorosis.Methods:A total of 40 male Wistar rats were divided into 4 groups (10 rats in each group) via the random number table method according to body weight (80 - 100 g), namely control group (drinking distilled water), low-dose, medium-dose and high-dose groups [drinking distilled water containing 50, 100 and 150 mg/L sodium fluoride (NaF), respectively]. The rats were free to drink and eat. After feeding for 90 days, rats were sacrificed and the aortic tissue was taken. Three aortic tissue samples from the control group and the high-dose group were taken for mRNA sequencing, the differential genes were screened, and the differential genes were analyzed by GO function enrichment analysis and KEGG function enrichment analysis. At the same time, the mRNA expression levels of PI3K, Akt and eNOS in the aortic tissue of rats in each group were determined by real-time fluorescence quantitative PCR.Results:Compared with control group, there were 756 differential genes in high-dose group, including 654 up-regulated genes and 102 down-regulated genes. These differential genes were mainly related to biological processes such as muscle contraction, muscle regulation, muscle tissue development, striated muscle cell development, muscle cell differentiation, blood circulation regulation and striated muscle tissue development. They were mainly enriched in cyclic guanosine phosphate (cGMP-PKG) signaling pathway, relaxin signaling pathway and PI3K/Akt signaling pathway, etc. Compared with control group, the mRNA expression levels of PI3K and eNOS in aortic tissue of rats in low-dose, medium-dose and high-dose groups were significantly reduced ( P < 0.05); the mRNA expression level of Akt in low-dose group was significantly increased ( P < 0.05). Conclusion:Fluoride exposure has certain effects on the function and gene expression of rat aortic tissue, and PI3K/Akt/eNOS signaling pathway may play an important role in the process of fluoride induced aortic tissue injury in rats.

Folic acid and vitamin B 12 inhibit arsenic-induced apoptosis in SH-SY5Y cells via Bcl-2/Bax pathway / 中华地方病学杂志

Objective:To explore the arsenic trioxide (As 2O 3)-induced apoptosis of human neuroblastoma cells (SH-SY5Y cells) and the protection mechanisms of folic acid (FA) and vitamin B 12 (VB 12). Methods:SH-SY5Y cells were cultured in vitro and divided into six groups by group design: control group (normal cultured), arsenic exposed group (10.00 μmol/L As 2O 3), FA intervention group (0.30 mmol/L FA + 10.00 μmol/L As 2O 3), VB 12 intervention group (0.06 mmol/L VB 12 + 10.00 μmol/L As 2O 3), combined intervention group (0.30 mmol/L FA + 0.06 mmol/L VB 12 + 10.00 μmol/L As 2O 3) and reagent control group (0.30 mmol/L FA + 0.06 mmol/L VB 12). Cells in each group were cultured for 24 h ( n = 3). Flow cytometry was used to determine the apoptosis rate of cells in each group. Transmission electron microscopy was used to observe the ultrastructural changes of the cells. The expression levels of mRNA and protein of apoptosis-related indicator B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X (Bax) were detected by fluorescence quantitative PCR and Western blotting. The activity of cysteinyl aspartate specific proteinase (Caspase) 3 was detected by luminescent assay. The above indicators were statistically analyzed. Results:There was statistically significant difference in the apoptosis rate among different groups ( F = 213.036, P < 0.05). The apoptosis rate in arsenic exposed group [(44.43 ± 3.54)%] was higher than that in control, FA intervention, VB 12 intervention, and combined intervention groups [(1.80 ± 0.06)%, (14.37 ± 0.13)%, (19.10 ± 1.56)%, (17.11 ± 2.34)%, P < 0.05]. Under transmission electron microscope, the apoptotic bodies, mitochondria swelling and degeneration, chromatin agglutination were observed in SH-SY5Y cells exposed to arsenic. The morphological and organelle changes of SH-SY5Y cells were significantly improved after respective and combined intervention of FA and VB 12. The expression levels of Bcl-2, Bax mRNA and protein were significantly different among different groups ( F = 5.178, 7.169, 6.142, 9.194, P < 0.05). The expression level of Bcl-2 protein in arsenic exposed group was lower than that in control group ( P < 0.05), and the expression levels of Bax mRNA and protein were higher than those in control group ( P < 0.05). The expression levels of Bcl-2 mRNA and protein in FA intervention group and combined intervention group were higher than those in arsenic exposed group ( P < 0.05), and Bcl-2 mRNA expression level in VB 12 intervention group was higher than that in arsenic exposed group ( P < 0.05). The expression levels of Bax mRNA and protein in FA intervention, VB 12 intervention and combined intervention groups were lower than those in arsenic exposed group ( P < 0.05). There were statistically significant differences in Caspase 3 activity among different groups ( F = 84.604, P < 0.05). Caspase 3 activity in arsenic exposed group was significantly higher than those in control, FA intervention, VB 12 intervention, and combined intervention groups ( P < 0.05). Conclusions:Arsenic exposure can lead to apoptosis and ultrastructural changes of SH-SY5Y cells. FA and VB 12 may effectively inhibit apoptosis through regulating Bcl-2/Bax pathway and decrease Caspase 3 activity, thus playing a protective role on nerve cells.

Protective effect of folic acid on oxidative stress injury and apoptosis of SH-SY5Y cells induced by arsenic / 中华地方病学杂志

Objective To investigate the effects of arsenic trioxide (As2O3) on oxidative stress and apoptosis of neuroblastoma cells (SH-SY5Y) and the protective effect of folic acid (FA).Methods SH-SY5Y cells were cultured in vitro,and were divided into six groups:control group,low arsenic group (2.5 μmol/L As2O3),medium arsenic group (5.0 μmol/L As2O3),high arsenic group (10.0 μmol/L As2O3),FA intervention group (10.0 μmol/L As2O3,0.3 mmol/L FA),and FA control group (0.3 mmol/L FA).Each group of cells was cultured for 24 h or 5 h.Cell chromatin agglutination was observed by fluorescence staining.The ultrastructure of cells was observed by transmission electron microscope.The changes of oxidative stress related indicators of glutathione (GSH),malondialdehyde (MDA),superoxide dismutase (SOD),and reactive oxygen species (ROS) were detected;caspase 3 activity was also detected.Results Under fluorescence microscope,as the dose of arsenic increased,the nucleus became increasingly highlighted and a small number of cells in the medium and high arsenic groups showed chromatin agglutination,and FA intervention reduced chromatin agglutination.Under transmission electron microscope,the mitochondria of low and medium arsenic groups were slightly swollen and the endoplasmic reticulum was expanded;while the mitochondria of high arsenic group were significantly swollen and the nuclear membrane was ruptured,and the apoptotic bodies were observed.Mitochondria were slightly swollen after FA intervention.There were statistically significant differences in GSH content,SOD activity,ROS level and caspase 3 activity between groups (F =14.905,6.120,12.714,36.657,P ＜ 0.05).GSH content and SOD activity in high arsenic group [0.104 ± 0.074,(12.673 ± 5.106) U/mg prot] were lower than those in control group [1.000 ± 0.000,(34.699 ±3.998) U/mg prot,P ＜ 0.05].GSH content in FA intervention group (0.411 ± 0.344) was higher than that in high arsenic group (P ＜ 0.05).The ROS level and caspase 3 activity in high arsenic group were higher than those in control group (P ＜ 0.05),and the ROS level and caspase 3 activity in FA intervention group were lower than those in high arsenic group (P ＜ 0.05).There was no significant difference in MDA content between groups (F =8.207,P ＜ 0.05).Conclusions Arsenic exposure can inhibit the activity of antioxidants,cause oxidative stress injury,and increase the activity of caspase 3,leading to cell apoptosis.FA plays an antagonistic role in arsenicinduced oxidative damage and apoptosis of nerve cells.

Clinical effect of transarterial chemoembolization combined with endovascular implantation of iodine-125 seeds in treatment of primary liver cancer complicated by portal vein tumor thrombus / 临床肝胆病杂志

Objective To investigate the clinical effect of transarterial chemoembolization (TACE) combined with endovascular implantation of iodine-125 seeds in the treatment of primary liver cancer complicated by portal vein tumor thrombus (PVTT) and its influence on liver function. Methods A retrospective analysis was performed for the clinical data of 96 patients with primary liver cancer complicated by PVTT who were admitted to Guangzhou No. 12 People's Hospital from January 2013 to December 2016. Among these patients, 52 were treated with TACE combined with endovascular implantation of iodine-125 seeds in the portal vein (combination group) and 44 were treated with TACE alone (control group) . The two groups were compared in terms of the outcome of tumor lesions and PVTT and the changes in related laboratory markers after treatment. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the combination group had significantly higher remission rates of tumor lesions (59. 62％ vs 38. 64％, χ2= 4. 196, P = 0. 041) and PVTT (80. 77％ vs 59. 09％, χ2=5. 421, P = 0. 020) . At 8 weeks after surgery, the combination group had significantly lower serum alpha-fetoprotein (AFP), diameter of the main portal vein, and platelet count (PLT) and significantly higher serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) than the control group (t = 3. 891, 3. 291, 2. 330, 3. 729, 3. 582, and 4. 126, all P ＜0. 05); both groups showed significant increases in serum levels of ALT, AST, and TBil (all P ＜ 0. 05) and significant reductions in PLT, serum AFP and diameter of the main portal vein (all P ＜ 0. 05) . Conclusion TACE combined with endovascular implantation of iodine-125 seeds in the portal vein has a better clinical effect than TACE alone in the treatment of primary liver cancer complicated by PVTT, but more attention should be paid to liver impairment during treatment.

Practice and Analysis of Clinical Pharmacist Participating in the Consultation for 39 Cases of Acinetobacter baumannii Infection / 中国药房

OBJECTIVE:To investigate the methods and breakthrough point of clinical pharmacist participating in the consulta-tion for Acinetobacter baumannii infection cases,in order to improve the level of clinical rational drug use. METHODS:The con-sultation records of 39 A. baumannii infection cases in neurology department of our hospital during 2013-2014 were analyzed retro-spectively. The patients’general condition,site of infection,bacterial culture and drug sensitivity test were analyzed statistically as well as drug regimen before and after consultation,disease condition,lab indexes and nutritional status. RESULTS:A. baumannii were found in sputum culture of all patients,among which there were 11 cases of multiple resistant bacteria(28.2%),13 cases of pan resistant bacteria (33.3%),8 cases of drug resistant A. baumannii (20.5%) and 7 cases of non-multiple resistant bacteria (17.9%). The most widely used drug was minocycline (average dose of 0.2 g/d),followed by cefoperazone-sulbactam (average dose of 9 g/d),ceftazidime (average dose of 6 g/d), etimicin (average dose of 0.27 g/d),amikacin (average dose of 0.4 g/d). The antibacterial daily doses were higher than before. 3 patients were recommended to use fosfomycin. Before consultation,2 pa-tients didn’t received antibiotics (5.1%),and there were 13 cases of single drug (33.4%),22 cases of two-drug combination (56.4%)and 2 cases of three-drug combination(5.1%). After consultation,none of patients didn’t received antibiotics(0),and there were 7 cases of single drug (17.9%),26 cases of two-drug combination (66.7%) and 6 cases of three-drug combination (15.4%). After the consultation,body temperature,symptom and infection indexes of patients got better. Clinical pharmacists ad-justed nutrition program of 12 patients (30.8%) and expecterant program of 9 patients (23.1%). Compared with before consulta-tion,oubumin level of 11 patients (28.2%) and prealbumin level of 20 patients (51.3%) were all increased. CONCLUSIONS:Clinical pharmacist should formulate reasonable therapeutic regimen and reduce irrational drug use according to infection and physi-cal condition. They should provide anti-infective regimen,at the same time,pay attention to the adjustment of expectorant regimen and nutrition support program.

Tumor targeting efficacy of a novel PET radiotracer (1)8F-AlF-NOTA-PRGD2 in mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the tumor targeting efficacy of (18)F-AlF-NOTA-PRGD2, a novel radiotracer of Arginine-glycine-aspartic acid (RGD) peptides.</p><p><b>METHODS</b>(18)F-AlF-NOTA-PRGD2 was synthesized in one-step by conjugating NOTA-PRGD2 with (18)F-AlF at 100 degrees celsius;. The tumor targeting efficacy and in vivo biodistribution profile of (18)F-AlF-NOTA-PRGD2, following intravenous injection via the tail vein, were evaluated in a nude mouse model bearing subcutaneous U87MG glioblastoma xenograft by radioactivity biodistribution assessment, PET/CT and microPET/CT.</p><p><b>RESULTS</b>NOTA-PRGD2 was (18)F-fluorinated successfully in one-step with a yield of 17%-25% within 15-20 min. Radioactivity biodistribution study confirmed the tumor-targeting ability of (18)F-AlF-NOTA-PRGD2 in the tumor-bearing mice. At 1 and 2 h following injection, (18)F-AlF-NOTA-PRGD2 uptake in the tumor reached 4.14∓1.44 and 2.80∓1.18 % ID/g (t=1.910, P=0.070) with tumor/brain ratios of 2.95∓0.61 and 5.21∓2.62, respectively (t=-1.686, P=0.167). Both PET/CT and microPET/CT were capable of showing the radioactivity biodistribution of (18)F-AlF-NOTA-PRGD2 in the mouse model and clearly displayed the tumor, but microPET/CT showed a much better image quality.</p><p><b>CONCLUSION</b>(18)F-AlF-NOTA-PRGD2 prepared by one-step radiosynthesis can selectively target to the tumor, demonstrating its potential as a good radiotracer for tumor imaging.</p>

Value of dual-phase (18)F-FDG PET/CT in preoperative staging of bladder cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical value of dual-phase (18)F-FDG PET/CT with oral diuretics in preoperative staging of bladder cancer.</p><p><b>METHODS</b>The imaging data were analyzed of 73 patients with bladder cancer undergoing preoperative dual-phase (18)F-FDG PET/CT with oral diuretic between May, 2003 and May, 2012. All the patients underwent whole-body PET/CT scan 60 min after intravenous injection of 270-350 MBq of (18)F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis using oral furosemide (40 mg). All the patients underwent subsequent radical cystectomy, and (18)F-FDG PET/CT findings were compared with the histopathologic results to evaluate the value of dual-phase (18)F-FDG PET/CT in preoperative staging.</p><p><b>RESULTS</b>The concordance rate of dual-phase FDG PET/CT-based bladder cancer staging with the histopathologic results was 63.0% in the 73 patients, and was 100% (7/7) for pT4 bladder cancers. With dual-phase FDG PET/CT, the detection rate was 75.0% (6/8) for lymph node metastases, 100% (4/4) for distant metastases, and 100% (4/4) for other concurrent primary malignancies.</p><p><b>CONCLUSION</b>Though with limited accuracy in T-staging of pTa, pT1, pT2, and pT3 bladder cancer, dual-phase FDG PET/CT has important clinical value in staging of pT4 bladder cancer and in N-staging, M-staging and detection of other concurrent primary malignancies.</p>

Value of the dual phase 18F-FDG PET/CT in the diagnosis of recurrent and metastatic bladder cancer after surgery / 实用医学杂志

Objective To investigate the clinical value of dual phase 18F-FDG PET/CT in the diagnosis of recurrent and metastatic bladder cancer after surgery. Methods The imaging data from 84 patients underwent the dual phase 18F-FDG PET/CT after surgery with known histories of bladder cancer were analyzed. Among the 84 patients, 16 had symptoms of recurrence, 24 had symptoms of metastasis and 44 didn′t have any symptom. The median interval time between the primary tumor resection and the PET/CT scan was 11.5 months (0.5 ~ 240 months). According to the PET/CT imaging procedures, all patients underwent whole body PET/CT scan at 60 minutes after IV injection of 18F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis by using oral 40 mg furosemide. The 18F-FDG PET/CT findings were compared with histopathologic examination results and (or) the clinical follow-up. All patients were followed up for more than six months. Results Results of detecting recurrence and metastasis of bladder cancer showed that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the dual phase FDG PET/CT imaging protocol were 91.7%(22/24), 95.0%(57/60), 94.0%(79/84), 88.0%(22/25), 96.6%(57/59) and 90.0%(27/30), 96.3%(52/54), 94.0%(79/84), 93.1%(27/29), 94.5%(52/55), respectively. Conclusion Dual phase FDG PET/CT can be used to detect the recurrence and metastasis with high accuracy, contributing to the restaging and follow-up in bladder cancer after surgery.

Clinical research of early oral feeding in mild acute pancreatitis patients / 肠外与肠内营养

Objective: In acute pancreatitis, traditional treatment insists fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. The aim of our study was to evaluate the efficacy and feasibility of early oral feeding as compared to traditional fasting in patients with mild acute pancreatitis.Methods: Seventy-two patients were randomized to the two treatment groups, fasting or early oral feeding. The inclusion criteria were pancreas amylase≥3times above normal, onset of abdominal pain within 48h, acute physiological and chronic health evaluation-II score<8 and C-reactive protein(CRP)<150 mg/L. Measures were amylase, systemic inflammatory response, length of hospital stay. Results: The groups were comparable with respect to age, sex, etiology, APACHE II, time from onset of pain and amylase at admission. No significant differences were seen between the groups concerning levels of amylase, CRP, leukocytes, abdominal pain or number of gastrointestinal symptoms. The length of hospital stay time was significantly shorter in the oral feeding group (13 vs. 17 days; P<0.05).Conclusion: Early oral feeding would not exacerbate disease process. The differences between treatment groups for amylase or systemic inflammatory response were not obvious. In mild acute pancreatitis, early oral feeding was feasible and safe and may accelerate recovery.