Clinical characteristics of acute renal infarction: an analysis of 15 cases / 中华全科医师杂志

Clinical data of 15 patients diagnosed with acute renal infarction (ARI) in Affiliated Zhongshan Hospital of Dalian University from Jan 2011 to Dec 2021 were retrospectively analyzed. Of the included 15 patients, there were 14 cases of cardiac origin and 1 case of antiphospholipid syndrome. We found that there were 12 cases of atrial fibrillation, 2 cases of atrial premature beats, 12 cases of elevated level of D-dimer, 15 cases of elevated level of LDH, 11 cases of positive urine occult blood and positive urine protein. Among the 15 patients, catheter-directed thrombolysis was performed in 4 cases, of which 3 cases were revascularized successfully, intravenous thrombolysis in 2 cases and alone anticoagulation therapy in 9 cases. It is suggested that CECT or CTA can assist the early diagnosis of ARI especially in patients with acute onset and persistent abdominal pain with high risk factors of thromboembolism, high levels of LDH, microscopic hematuria and/or proteinuria. Despite prolonged embolic ischemia, try to reconstruct blood flow to save the kidney as much as possible. Late standardized anticoagulant therapy is of critical importance to prevent recurrent embolic episodes.

Research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics / 中华创伤杂志

Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.

Treatment status of patients over 65 years old with hypertension and multimorbidity in Qinghai / 公共卫生与预防医学

Objective To investigate the treatment status of patients over 65 years old with hypertension and multimorbidity in Qinghai, so as to provide reference for clinical treatment. Methods A total of 530 patients aged over 65 years old with hypertension involved multimorbidity in Qinghai were enrolled. The main disease types and polypharmacy were analyzed. Living with Medicines Questionnaire (LMQ) was used to assess the medical burden of patients, and the potentially inappropriate medication (PIM) was measured using screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria. Various indexes were analyzed, including age, gender, working status, marital status, educational level, solitary life, primary caregiver, sources of income, types of diseases, number of drugs per prescription and ways of obtaining prescriptions. The independent factors of irrational drug use in patients with hypertension and multimorbidity were discussed. Results ① Among the 530 subjects, the proportion of patients complicated with two diseases, three diseases, and four or more diseases was 71.70%, 20.00% and 8.30%, respectively. ② The top five combination types of multimorbidity were hypertension with coronary heart disease (26.04%), hypertension with dyslipidemia (16.04%), hypertension with diabetes (13.02%), hypertension with coronary heart disease and dyslipidemia (7.55%), hypertension with coronary heart disease and diabetes (3.96%).③ The types of drugs per prescription ranged from 1 to 11, with an average of 6.13 types, and the multiple medication rate reached 83.02% (440/530). ④ LMQ scale indicated that drug burden of patients with multimorbidity was at moderate to severe degree. ⑤ Taking STOPP/START as standard, the incidence of PIM was 32.64%.⑥ Multivariate Logistic regression analysis showed that education level and prescription obtained from secondary or above level hospitals were protective factors for PIM in patients with hypertension and multiple diseases, while the type of medication was a risk factor for PIM. Conclusion The elderly patients with hypertension and multiple diseases in Qinghai have a high multiple medication rate, and are in a state of moderate to severe drug burden, moreover, the PIM rate is also relatively high, so clinical standardization of drug use and reduction of drug burden are of vital importance.

Effect of losartan and irbesartan on blood pressure and ISI in female hypertension patients complicated with hyperuricemia / 中国基层医药

Objective To compare the effects of losartan and irbesartan on blood pressure,blood uric acid,insulin sensitivity and insulin resistance in female hypertensive patients complicated with hyperuricemia.Methods From August 2015 to December 2017,100 females of hypertension complicated with hyperuricemia who hospitalized in the Third People's Hospital of Ningxia were enrolled in the study.All the patients were divided into two groups according to the random digital table,with 50 cases in each group.The observation group was treated with losartan,and the control group was treated with irbesartan for 8 weeks.The total effective rate and adverse reactions were compared between the two groups.Also the changes of blood pressure,serum uric acid,fasting glucose (FBG),fasting insulin (FINS),high sensitivity C-reactive protein (hs-CRP),insulin sensitivity index (ISI) and insulin resistance index (HOMA-IR) were compared between the two groups after treatment.Results There was no statistically significant difference in the total effective rate between the two groups [92.0％ (46/50) vs.90.0％ (45/50)] (P ＞ 0.05).Before treatment,there were no statistically significant differences in blood pressure,serum uric acid,FBG,FINS,hs-CRP,ISI and HOMA-IR between the two groups (all P ＞ 0.05).After treatment,the systolic blood pressure and diastolic blood pressure in the two groups were (133.09 ± 10.11) mmHg vs.(131.54 ± 11.01) mmHg and (82.76 ± 6.23) mmHg vs.(83.75 ± 6.88) mmHg,which were lower than those before treatment (observation group:t =19.742,10.606,control group:t =18.925,-9.956,all P ＜ 0.05).But there were no statistically significant differences between the two groups (all P ＞ 0.05).After treatment,the serum uric acid in the observation group was lower than that in the control group [(387.21 ± 25.56) μmol/L vs.(429.67 ± 27.44) μmol/L] (t =8.006,P ＜ 0.05).The hs-CRP,FINS,HOMA-IR,ISI in the observation group were (4.92 ± 1.02) rmg/L,(15.92 ± 3.01) mU/L,(1.71 ± 0.24),(1.047 ± 0.095),which in the control group were (4.54 ± 1.00) mg/L,(17.23 ± 3.20) mU/L,(1.65 ± 0.27),(1.140 ± 0.083).After treatment,the hs-CRP,FINS,HOMA-IR in the two groups were decreased (all P ＜ 0.05),while ISI was increased (P ＜ 0.05).Furthermore,the improvement of FINS,ISI and HOMA-IR in the observation group was better than those in the control group (t =2.109,-5.213,3.191,all P ＜ 0.05).Conclusion Both losartan and irbesartan can improve clinical symptoms,lower blood pressure and improve insulin resistance in female hypertension patients complicated with hyperuricemia,and losartan is more effective than irbesartan.

Anatomical and histological observation of ileocecal Treves fold and its clinical significance / 中华全科医师杂志

From December 2011 to August 2017,56 patients with acute abdomen surgery were treated in Affiliated Zhongshan Hospital of Dalian University.The anatomical structure of ileocecal Treves folds was observed during operation,and 15 samples of Treves folds were taken for histological examination.The mean length of the fold was (5.56±0.18)cm for males and (5.22±0.05)cm for female,the width was (1.82± 0.04) cm for males and (1.78 ± 0.06) cm for females;the thickness was (0.18 ± 0.02) cm.HE and verhoeff staining showed that Treves fold was mainly composed of elastic fiber,collagen fiber and smooth muscle with abundant blood supply.Thirty patients were repaired with their own Treves folds,including the fixation with overlay suture to the stump of appendectomy in 26 cases,repairing for perforation of colonic diverticulum in 3 case,and repairing for perforation of colonic diverticulum in 1 case.There were no complications such as fecal fistula,intestinal obstruction and intussusception after operation.The Treves fold has a constant location,which can be used as a clear sign of ileal terminal.It has abundant blood supply,and is suitable for the repair and reconstruction in ileocecal operation.

Sustained-released mixture of vascular endothelial growth factor 165 and fibrin glue strengthens healing of ileal anastomoses in a rabbit model with intraperitoneal infection

PURPOSE: To investigate the effects of a sustained-released mixture of vascular endothelial growth factor 165 (VEGF165) and fibrin glue (FG) local administration on postoperative rabbit ileal anastomoses. METHODS: One hundred twenty-eight male and female New Zealand white rabbits underwent intraperitoneal infection subsequent ileal anastomosis surgery were divided randomly into 4 groups, including 32 animals in each, applied with saline solution, FG, rhVEGF165 and a mixture of rhVEGF165 with FG (VEGF + FG) on the anastomoses, respectively. The incidences of anastomotic leakage were observed. Histopathological examination for inflammatory infiltration, fibroblast proliferation, and capillary vascular proliferation were performed. Then, bursting pressure and hydroxyproline concentrations were assessed in anastomoses sits on postoperative days 3, 5, 7, and 14. RESULTS: Rabbits in VEGF + FG group had the lowest incidence of leakage (P < 0.05). Histological evaluations revealed that granulation tissue was formed on days 5 after anastomosis; fibroblast proliferation and capillary vascular proliferation were significantly increased on days 7 and 14 in VEGF + FG group. Furthermore, there was a statistically significant difference in the mean bursting pressures between VEGF + FG group and other groups on days 7 and 14 (P < 0.05), and rabbits in VEGF + FG group exhibited a higher concentration than VEGF group (P < 0.05) and FG group (P < 0.05) on day 14. CONCLUSION: Administration of VEGF165 mixed with FG to ileal anastomosis accelerates wound healing and enhances the anastomosis by increased angiogenesis.

The protective effect of sodium pyruvate solution to intestinal barrier in hemorrhagic shock rats by intraperitoneal resuscitation / 中华急诊医学杂志

Objective To study the protective effect of sodium pyruvate solution to intestinal barrier in Hemorrhagic shock rats by intraperitoneal resuscitation.Methods A total of 40 Male SD ratswere healthy and clean,were randomly (random number) divided into four groups:sham operation group (group Ⅰ),hemorrhagic shock model group (group Ⅱ),the recovery of the compound sodium chloride intravenous + intraperitoneal recovery of the PD-2 liquid group (group iiⅢ),the recovery of the compound sodium chloride intravenous + sodium pyruvate abdominal recovery group (group Ⅳ) (n =10).In addition to the group Ⅰ,the other three groups are used the HS model by The Wiggers improvement prepared,group Ⅲ,Ⅳ were used the same amount of intravenous recovery,At the same time to the abdominal cavity were respectively injected 20 mL 2.5％ PD-2 liquid and 20 m 2.5％ sodium pymvate solution.After 2 h,each group were taken arterial blood measured arterial blood gases (pH,PaCO2,PaO2) and D-lactic acid,small intestine specimens under the light microscope to observe the morphological changes of the rat small intestinal mucosa.Results Blood gas analysis:group Ⅲ and Ⅳ was significantly increased compared with group Ⅱ in pH levels and PaO2 content (P ＜ 0.01),and comoared to group Ⅲ,pH levels and PO2 levels of group Ⅳ increased more significantly (P ＜ 0.05) ; D-LA content:Group Ⅲ,Ⅳgroup is significantly lower than group Ⅱ (P ＜ 0.01) ; compared with group Ⅲ and group Ⅳ,D-LA significantly decreased (P ＜ 0.05).Light microscope,the group Ⅱ,the rat small intestine layer of a high degree of villous edema,submucosal vascular collapse within the lamina propria glands focal area of necrosis,and large areas of mucosal villi necrosis,defects; group Ⅲ and group Ⅳof small intestinal damage compared to group Ⅱ significantly reduced; Ⅳgroup of the rat small intestine villi edema,lodging and the degree of necrosis in group Ⅲ.Intestinal epithelial damage index score:the Ⅳ group than in group Ⅱ and Ⅲ group (P ＜ 0.01 or P ＜ 0.05).Conclusions The venous recovery and intraperitoneal resuscitation can significantly reduce the plasma D-LA content of hemorrhagic shock in rats,correct acidosis,increase the oxygen partial pressure ; and intestinal mucosal barrier function,the protective of sodium pyruvate solution is better than the PD-2 liquid.

Clinical effect of selective uterine artery embolization in obstetrics and gynecology postoperative bleeding / 中国医师进修杂志

Objective To investigate the clinical effect of selective uterine artery embolization in obstetrics and gynecology postoperative bleeding.Methods The clinical data of 19 patients with obstetrics and gynecology postoperative bleeding undergoing selective uterine artery embolization were analyzed retrospectively,including 15 cases of cesarean and 4 cases of uterectomy.Results Nineteen patients were uterine artery bleeding.All patients were diagnosed by digital subtraction angiography (DSA) and embolization were disposable success.No complications such as organ necrosis or visceral dysfunction occurred.Conclusions DSA has advantages of minimally invasive,significant effect,less adverse reaction,quick recovery and easier to be accepted by the patients in diagnosis and interventional treatment of postoperative bleeding in obstetrics and gynecology.Selective uterine artery embolization has a wide range of application and development prospect in the field of obstetrics and gynecology.

Application of round hepatic and falciform ligaments in acute abdominal repair: a report of 22 cases / 中华全科医师杂志

Retrospective study was conducted to analyze the efficacies of using round hepatic and falciform ligaments in acute abdominal repair for 22 cases between December 2010 to March 2013.There was no occurrence of perioperative mortality.Twenty patients (90％) were followed up for 3 to 24 months.All cases recovered favorably and no complications of common bile duct stricture,bile leakage,postoperative hemorrhage or pancreatic fistula occurred.The anatomic and morphological advantages of pedicled ligamentum teres hepatic and falciform ligaments have made it a high-quality autologous biological repair material applicable for a variety of acute abdominal repairs.

The thoracic CT manifestations and pathologic basis of pulmonary Wegener granulomatosis / 中国医师进修杂志

Objective To explore the thoracic CT manifestations and pathologic basis of pulmonary Wegener granulomatosis (WG),in order to improve the diagnostic accuracy.Methods Eighteen patients with pulmonary WG confirmed by pathology were collected.All the patients underwent CT scan and enhanced scan with 64-slice volume CT.CT features and clinical symptoms were retrospectively reviewed.Results The pathological manifestations of 18 cases with pulmonary WG were miscellaneous,including necrotizing granuloma infiltrated with inflammatory cells,intrapulmonary vasculitis,parenchymal necrosis,hemorrhage of pulmonary alveolus,microabscess and so on.Thoracic CT manifestations:multiple nodules were seen in 7 cases,multiple masses were detected in 4 cases,cavitations showed in 10 cases,peripheral wedge-shaped shadows showed in 2 cases,ground-glass attenuation and consolidation showed in 2 cases,bronchial wall thickening in 2 cases,solitary pulmonary nodule or mass in 3 cases,pleural effusion was seen in 5 cases.All the nodules,masses and cavitations demonstrated inhomogeneous and ring enhancement on contrast-enhanced images.Some patients presented with varied kinds of the above lesions,which could transform each other and became more or less.Conclusions Pulmonary WG has many pathological manifestations,resulting in the variety of the thoracic CT manifestations.The main manifestations are multiple nodules and multiple masses,necrotic cavitations.The feeding vessel sign to a nodule or mass and ring-shade cavity are relatively characteristics to diagnose pulmonary WG.The correct diagnosis could be established on the bases of understanding of the special developments and pathology of the lesions.

Effect of Dahuang Fuzi decoction on alveolaur epithelial barrier in rats with lung injury with severe acute pancreatitis / 中华急诊医学杂志

Objective To investigate effect of Dahuang Fuzi decoction on alveolaur epithelial barrier in rats with lung injury with severe acute pancreatitis. Method Ninty-six health SD rats were randomly divided into three groups: sham operation group, SAP-ALI group, Dahuang Fuzi decoction group, and then according to the time point of sacrifice after operation, each group was subdivided into 3,6,12,24 hour subsets ( each, n = 8). After the belly of a rat in the sham operation group was cut open, the pancreas was flipped several times,and then a stoma was made in the jejunum to form its fistula. In the SAP-ALl group,1 mL/kg sodium taurocholate was reversely injected into the pancreatobile duct to establish the model of SAP, and then the jejimum fistula was performed. The SAP-ALI model in Dahuang Fuzi decoction group was treated by injection of 10ml of Dahuang Fuzi decoctionon into the fistula respectively. Blood was collected from heart to detect serum amvlase and endotoxin (ET) levels before the rat being executed. The lung histopathologic changes, pulmonary injury scores and wet/dry weight(W/D) ratios were observed after the rats were executed. The alveolar liquid clearance rate(ALCR), total lung water content (TLW), extravascular lung water content(EVLW) and alveolar epithelial permeability (AEP) were examined in 3,6, 12,24 h after injury.Results There was continuous increase of AEP,TLW and EVLW,as well as progressive reduction of ALCR compared with sham operation group at 3,6,12,24 h after operation. Compared with SAP-ALI group, there was continuous decrease of AEP,TLW and EVLW, and elevated of ALCR at 3,6,12,24 h after operation.Conclusions Dahuang Fuzi decoction can significantly reduce alveolaur epithelial barrier and degree of lung tissue of SAP-ALI rats by inhibiting the elevation of LPS and inflammation reaction.

Protective effects of Dahuangfuzi decoction on the intestine barrier functional of acute necrotizing pancreatitis in rats / 中华胰腺病杂志

Objective To observe the effects of Dahuangfuzi decoction on the intestine barrier functional of acute necrotizing pancreatitis in rats. Methods The 60 rats were randomly divided into sham operation group ( n = 19 ), ANP group ( n = 21 ), and Dahuangfuzi treatment group ( n = 20). The rats of ANP group were induced by injecting 1 ml/kg of 4% sodium taurocholate into the pancreatiobiliary duct, and jejunal fistula was esablished. The rats of treatment group received Dahuangfuzi decoction (2 ml, repeated at 4 and 8 h)through jejunum distal stoma tube 0. 5 h after ANP induction. The other 2 groups received same amount of normal saline. Blood sample was collected through abdominal aorta, 24 h after ANP induction, and the serum amylase, endotoxin, D-lactate, plasma diamine oxidase (DAO) were detected. Pancreas, small intestine tissue was harvested for pathologic examination, index of intestinal epithelial damage was measured and ultrastructural changes in small intestinal mucosa was observed. Results The expression of serum amylase, endotoxin,D-lactate, DAO in sham operation group was ( 152 ± 32 ) U/L, (6.95 ± 2.10) pg/L, ( 3.96 ± 1.08 ) μg/mland ( 14.26 ± 2.67 ) μg/ml, while the corresponding values were ( 1549 ± 93 ) U/L, (40.48 ± 3.41 ) pg/L,( 12.34 ± 1.23 ) μg/ml and ( 80.28 ± 3.54) μg/ml in ANP group, and they were (655 ± 49 ) U/L, ( 19.55 ±2.50) pg/L, (6.75 ± 1.36 ) μg/mland ( 20.69 ± 7.53 ) μg/ml in treatment group. The values in ANP group were significantly higher than those in sham operation group. The values in treatment group were significantly lower than those in ANP group, but significantly higher than those in sham operation group ( P ＜ 0.05 or P ＜0. 01 ). The thickness and height of intestinal mucosa in ANP group were ( 389.44 ± 29.87 )μm and ( 16.52 ±3.73) μm, which were significantly lower than those in treatment group [(501.95 ± 45.38 )μm, (27.82 ±5.17)] μm, and in sham operation group [( 658.72 ± 57.49 ) μm, ( 35.49 ± 6.43 )μm, Index of intestional epitholial donage in ANP group was 3.72 ± 0.65 which is significently higher than those in theatment (2.12 ±0.37 ) and in sham operation group (0.85 ± 0.24). The intestinal mucosa histological and ultrastructural changes in Dahuangfuzi treatment group were better than those in ANP group. Conclusions Dahuangfuzidecoction can significantly decrease the damage of intestine barrier function in ANP rats.

Minimally invasive perventricular vsd closure without cardiopulmonary bypass mid-term results from multi-centers / 中华胸心血管外科杂志

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.