Efficacy analysis of inferior vena cava variability combined with difference of central venous-to-arterial partial pressure of carbon dioxide on guiding fluid resuscitation in patients with septic shock / 中华危重病急救医学

Objective:To investigate the effect of inferior vena cava variability (IVCV) combined with difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO 2) on guiding fluid resuscitation in septic shock. Methods:Patients with septic shock admitted to the department of critical care medicine of Jiangxi Provincial People's Hospital from January 1, 2018 to December 31, 2020 were enrolled, and they were divided into control group and observation group according to random number table method. Patients in both groups were given fluid resuscitation according to septic shock fluid resuscitation guidelines. The patients in the control group received fluid resuscitation strictly according to the early goal-directed therapy (EGDT) strategy. Resuscitation target: central venous pressure (CVP) 12-15 cmH 2O (1 cmH 2O≈0.098 kPa), mean arterial pressure (MAP) > 65 mmHg (1 mmHg≈0.133 kPa), mean urine volume (UO) > 0.5 mL·kg -1·h -1, central venous oxygen saturation (ScvO 2) > 0.70. In the observation group, the endpoint of resuscitation was evaluated by IVCV dynamically monitored by bedside ultrasound and Pcv-aCO 2. Resuscitation target: fixed filling of inferior vena cava with diameter > 2 cm, IVCV < 18%, and Pcv-aCO 2 < 6 mmHg. The changes in recovery indexes before and 6 hours and 24 hours of resuscitation of the two groups were recorded, and the 6-hour efficiency of fluid resuscitation, 6-hour lactate clearance rate (LCR) and 6-hour and 24-hour total volume of resuscitation were also recorded; at the same time, the duration of mechanical ventilation, length of intensive care unit (ICU) stay, 28-day mortality and the incidence of acute renal failure and acute pulmonary edema between the two groups were compared. Results:A total of 80 patients were enrolled in the analysis, with 40 in the control group and 40 in the observation group. The MAP, CVP and ScvO 2 at 6 hours and 24 hours of resuscitation in the two groups were significantly higher than those before resuscitation, while Pcv-aCO 2 and blood lactic acid (Lac) were significantly decreased, and UO was increased gradually with the extension of resuscitation time, indicating that both resuscitation endpoint evaluation schemes could alleviate the shock state of patients. Compared with before resuscitation, IVCV at 6 hours and 24 hours of resuscitation in the observation group were decreased significantly [(17.54±4.52)%, (18.32±3.64)% vs. (27.49±10.56)%, both P < 0.05]. Compared with the control group, MAP and ScvO 2 at 6 hours of resuscitation in the observation group were significantly increased [MAP (mmHg): 69.09±4.64 vs. 66.37±4.32, ScvO 2: 0.666±0.033 vs. 0.645±0.035, both P < 0.05], 24-hour MAP was increased significantly (mmHg: 75.16±3.28 vs. 70.12±2.18, P < 0.05), but CVP was relatively lowered (cmH 2O: 9.25±1.49 vs. 10.25±1.05, P < 0.05), indicating that the fluid resuscitation efficiency was higher in the observation group. Compared with the control group, 6-hour LCR in the observation group was significantly increased [(55.64±6.23)% vs. (52.45±4.52)%, P < 0.05], 6-hour and 24-hour total volume of resuscitation was significantly decreased (mL: 2 860.73±658.32 vs. 3 568.54±856.43, 4 768.65±1 085.65 vs. 5 385.34±1 354.83, both P < 0.05), the duration of mechanical ventilation was significantly shortened (days: 6.78±3.45 vs. 8.45±2.85, P < 0.05), while the incidence of acute pulmonary edema was significantly decreased [2.5% (1/40) vs. 20.0% (8/40), P < 0.05]. There was no significant difference in the length of ICU stay, 28-day mortality or incidence of acute renal failure between the two groups. Conclusions:Dynamic monitoring of IVCV and Pcv-aCO 2 can effectively guide the early fluid resuscitation of patients with septic shock, and compared with EGDT, it can significantly shorten the duration of mechanical ventilation, reduce the amount of fluid resuscitation, and reduce the incidence of acute pulmonary edema. Combined with its non-invasive characteristics, it has certain clinical advantages.

Celastrol alleviates sepsis-induced acute lung injury in rats by inhibiting the Toll-like receptor 4/nuclear factor-κB inflammatory pathway / 中华危重病急救医学

Objective:To investigate the protective effect and mechanism of celastrol in acute lung injury (ALI) of septic rats.Methods:According to random number table, 24 male Sprague-Dawley (SD) rats were divided into control group (Con group), Sham operation group (Sham group), sepsis-induced ALI group by cecal ligation and perforation (CLP group) and celastrol intervention group (CLP+celastrol group, 2 mg/kg intraperitoneal administration 1 hour before surgery), 6 rats in each group. The abdominal aortic blood of the rats was collected for blood gas analysis 24 hours after the surgery, and then the rats were sacrificed and the lung tissues were taken to calculate the lung wet/dry weight ratio (W/D). The pathological characteristics of lung tissues were observed under light microscope and calculated the lung injury score. The protein levels of Toll-like receptor 4 (TLR4), interleukins (IL-6, IL-10), and nuclear factor-κB (NF-κB) of cytoplasm and nucleus in lung tissues were detected by enzyme linked immunosorbent assay (ELISA).Results:The partial arterial oxygen pressure (PaO 2), lung W/D ratio, lung injury score and the protein levels of inflammatory factor in lung tissues had no differences between Con group and Sham group. Compared with the Con group, PaO 2 in the CLP group was significantly decreased [mmHg (1 mmHg = 0.133 kPa): 60.33±2.01 vs. 109.20±2.99], the lung W/D ratio and lung injury score were significantly increased (lung W/D ratio: 4.44±0.05 vs. 3.27±0.04, lung injury score: 10.67±0.42 vs. 0.50±0.22), and the protein levels of TLR4, IL-6, IL-10 and the nucleus NF-κB in the lung tissues were significantly increased [TLR4 (pg/L): 21.87±0.66 vs. 3.27±0.09, IL-6 (ng/L): 861.10±8.28 vs. 120.30±3.91, IL-10 (ng/L): 212.40±2.57 vs. 41.73±1.02, nuclear NF-κB (ng/L): 707.70±16.82 vs. 403.30±7.46], but the protein level of cytoplasm NF-κB was significantly decreased (ng/L: 213.70±8.67 vs. 408.30±8.71), with statistically significant differences (all P < 0.05). Compared with the CLP group, PaO 2 in CLP+celastrol group was significantly increased (mmHg: 76.83±3.21 vs. 60.33±2.01), the lung W/D ratio and lung injury score were significantly decreased (lung W/D ratio: 3.82±0.03 vs. 4.44±0.05, lung injury score: 5.00±0.37 vs. 10.67±0.42), and the protein levels of TLR4, IL-6, IL-10 and nucleus NF-κB in the lung tissue were significantly decreased [TLR4 (pg/L): 7.57±0.21 vs. 21.87±0.66, IL-6 (ng/L): 380.90±6.55 vs. 861.10±8.28, nuclear NF-κB (ng/L): 533.80±9.42 vs. 707.70±16.82], and the protein level of cytoplasm NF-κB was significantly increased (ng/L: 342.70±14.96 vs. 213.70±8.67), with statistically significant differences (all P < 0.05), while the protein level of IL-10 in lung tissues had no significant difference (ng/L: 210.50±3.16 vs. 212.40±2.57, P > 0.05). Conclusion:Celastrol may regulate the expression and release of inflammatory factors by inhibiting the TLR4/NF-κB pathway, thereby alleviating the ALI induced by sepsis in rats.

Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases / 中华危重病急救医学

Objective? ? To? evaluate? the? protective? effect? and? curative? effect? of? early? treatment? with?extracorporeal?membrane?oxygenation?(ECMO)?in?severe?patients?with?acute?respiratory?distress?syndrome?(ARDS)?caused?by?acute?phosgene?poisoning.? Methods? The?course?of?treatment?of?4?cases?of?ARDS?caused?by?acute?phosgene?poisoning?admitted?to?intensive?care?unit?(ICU)?of?Jiangxi?Provincial?People's?Hospital?in?April?2018?was?retrospectively?analyzed.?The?treatment?parameters?in?patients?before?and?after?the?ECMO?treatment?at?1,?3,?7?days?were?collected,?including?pH?of?the?arterial?blood,?arterial?partial?pressure?of?carbon?dioxide?(PaCO2),?arterial?partial?pressure?of?oxygen?(PaO2),?blood?lactic?acid?(Lac)?and?systemic?vascular?resistance?index?(SVRI),?cardiac?index?(CI),?extravascular?lung?water?index?(ELWI),?plateau?pressure?(Pplat),?positive?end-expiratory?pressure?(PEEP),?driving?pressure?(ΔP),?and?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHE?Ⅱ),?the?length?of?ICU?stay,?the?treatment?duration?of?ECMO?and?the?duration?of?mechanical?ventilation.? Results? After?admitted?in?hospital,?the?4?patients?were?all?put?on?tracheal?intubation?and?ventilator,?but?the?ventilator?support?conditions?were?high,?the?oxygenation?and?internal?environment?were?unstable.?Therefore,?ECMO?therapy?was?performed?on?the?next?day?after?admission.?Oxygenation?was?improved?obviously?after?treatment,?ventilator?support?conditions?could?be?obviously?reduced,?including?3-6?mL/kg?of?the?small?tidal?volume,?8-10?cmH2O?(1?cmH2O?=?0.098?kPa)?of?the?PEEP,?0.30?of?the?inhaled?oxygen?concentration?(FiO2),?and?other?lung?protection?rest?strategies.?The?parameters?were?improved?obviously?after?the?ECMO?treatment?compared?with?before,?from?the?1st?day?after?the?ECMO?treatment,?PaO2,?SVRI?rose?obviously,?Lac,?ELWI,?Pplat,?PEEP,?ΔP,?APACHEⅡ?were?significantly?decreased?[PaO2??(mmHg,?1?mmHg?=?0.133?kPa):?85.5±10.7?vs.?54.2±4.5,?SVRI?(kPa·s·L-1·m-2):?153.6±9.4?vs.?118.0±12.6,?Lac?(mmol/L):?2.15±0.19?vs.?4.93±0.96,?ELWI?(mL/kg):?17.73±2.99?vs.?20.45±4.13,?Pplat?(cmH2O):?19.25±2.21?vs.?35.75±2.22,?PEEP?(cmH2O):?9.0±1.2?vs.?13.5±1.7,?ΔP?(cmH2O):?10.25±1.26?vs.?22.25±3.86,?APACHEⅡ:?17.25±2.22?vs.?26.50±2.08,?all?P?﹤0.05];?pH?and?CI?were?significantly?increased?after?3?days?treatment,?and?PaCO2?was?significantly?decreased?[pH:?7.43±0.05?vs.?7.21±0.13,?CI?(mL·s-1·m-2):?? 64.35±3.17?vs.?59.51±3.17,?PaCO2?(mmHg):?42.0±2.2?vs.?55.0±8.5,?all?P?<?0.05].?All?the?4?patients?were?treated?successfully?and?discharged?after?improvement.?The?length?of?ICU?stay?was?8-27?days,?with?an?average?(13.5±9.0)?days;?the?treatment?duration?of?ECMO?was?6-12?days,?with?an?average?(8.0±2.7)?days;?the?duration?of?mechanical?ventilation?was?6-20?days,?with?an?average?(10.75±6.19)?days.? Conclusion? Early?treatment?with?ECMO?can?significantly?improve?the?oxygenation?of?severe?ARDS?caused?by?acute?phosgene?poisoning,?eliminate?excessive?CO2?in?the?body,?reduce?ventilator-associated?lung?injury,?and?improve?the?prognosis.

Application of endoscopic purse-string sutures with titanium clips and endoloops for the gastric wall defect during endoscopic full-thickness resection / 中国内镜杂志

Objective To study the application value of endoscopic purse-string sutures with titanium clips and endoloops for the gastric wall defect during endoscopic full-thickness resection (EFTR). Methods Data of iffteen hospitalized patients with gastric submucosal tumor (SMT) undergone EFTR was reviewed. The patients were all applied with endoscopic purse-string sutures with titanium clips and endoloops, which was performed after the EFTR when the gastric walls were perforated artiifcially. Results The gastric tumors were complete successfully resected in the iffteen patients through endoscopic surgery, applied the purse-string sutures with titanium clips and endoloops after the EFTR when the gastric walls were perforated artiifcially. Approximately, ifve clips were utilized on average. Postoperative surgical wound healing was followed up for 6 months, no tumors recurred. Conclusion It is safe, minimally invasive treatment method for rapid rehabilitation in endoscopic full-thickness resection utilized purse-string sutures with titanium clips and endoloops.

VEGF165 transfected endothelial progenitor cells mediated by lentivirus alleviated ALI in rats / 中华危重病急救医学

Objective To investigate the protective effects of vascular endothelial growth factor-165 (VEGF165) transfected the endothelial progenitor cells (EPCs) mediated by lentivirus on acute lung injury (ALI) in rats. Methods The mononuclear cells from the male Sprague-Dawley (SD) rats were isolated and cultured to get the EPCs for study. The lentivirus vector carrying the human VEGF165 gene was constructed. According to the random number table method, 90 male SD rats were divided into ALI model group, phosphate buffer solution (PBS) group, EPCs treatment group, none transfected EPCs treatment group and VEGF165 transfected EPCs treatment group, and the rats in each group were subdivided into 4, 12 and 48 hours subgroups, with 6 rats in each subgroup. The rat model of ALI was reproduced by intravenous injection of oleic acid (0.15 μL/g). Then each treatment group was given PBS, EPCs, none transfected EPCs and VEGF165 transfected EPCs respectively with the same volume of 0.2 mL. For the groups with cells, about 1×106cells were contained. Abdominal aortic blood and lung tissue were harvested at 4, 12 and 48 hours. Arterial blood gas analysis was performed. The lung wet/dry weight ratio (W/D) was calculated. The expressions of induced nitric oxide synthase (iNOS), endothelin-1 (ET-1) and VEGF165 were determined by enzyme-linked immunosorbent assay (ELISA). After dyed with hematoxylin-eosin (HE), the lung tissue pathology was observed and the lung injury score was performed. Results Compared with the ALI model group, the arterial partial pressure of oxygen (PaO2) in EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups was significantly increased from 4 hours, and lung W/D, expressions of iNOS and ET-1 were significantly decreased, and VEGF165 expression was significantly increased. Compared with the EPCs treatment group, the increase in PaO2, the decrease in lung W/D and expressions of iNOS and ET-1, and the increase in VEGF165 expression in VEGF165 transfected EPCs treatment group were more significant [4 hours: PaO2(mmHg, 1 mmHg = 0.133 kPa) was 82.84±10.69 vs. 72.34±9.36, lung W/D ratio was 4.83±0.23 vs. 5.55±0.37, iNOS (ng/mg) was 8.77±1.10 vs. 14.84±1.34, ET-1 (ng/mg) was 103.41±5.66 vs. 153.08±5.12, VEGF165 (ng/mg) was 130.56±12.16 vs. 83.03±5.95; 12 hours: PaO2(mmHg) was 91.67±6.81 vs. 78.5±8.81, lung W/D ratio was 4.44±0.35 vs. 5.32±0.25, iNOS (ng/mg) was 7.23±0.24 vs. 14.04±1.18, ET-1 (ng/mg) was 91.98±3.52 vs. 125.99±7.55, VEGF165 (ng/mg) was 164.49±5.71 vs. 96.61±6.12]; individual parameters reached valley value or peak value at 48 hours [lung W/D ratio was 4.26±0.30 vs. 4.89±0.15, iNOS (ng/mg) was 5.79±0.85 vs. 12.72±1.10, ET-1 (ng/mg) was 74.53±7.10 vs. 108.33±5.84, VEGF165 (ng/mg) was 237.43±10.79 vs. 134.24±11.99, all P < 0.05]. Over time, lung tissue injury in each group was gradually increased, and the lung injury score was gradually increased. The lung injury score at 48 hours in the EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups were lower than that in the ALI model group. Compared with the EPCs treatment group, the VEGF165 transfected EPCs treatment group had a lower score at 48 hours (8.50±1.05 vs. 10.50±1.05, P < 0.05). Conclusion The transplantation of EPCs which were transfected with VEGF165 mediated by lentivirus could obviously improve the oxygen pressure, reduce the lung water seepage, decrease the iNOS and ET-1 expressions in lung tissue, and had obvious protective effects on ALI.

The accuracy of Computed Tomography Angiography (CTA) in diagnosis of multiple intracranial aneurysms / 中国神经精神疾病杂志

Objective The purpose of this study is to explore the clinical value of CT angiography( CTA) in the diagnosis of multiple intracranial aneurysms.Methods The data of CTA and DSA from 74 patients with multiple intracra-nial aneurysms from July 2011 to March 2015 were reviewed retrospectively.Results One hundred seventy-seven aneu-rysms were detected by DSA, and 175 aneurysms were detected by CTA.Among the aneurysms identified by CTA, 4 aneu-rysms were false positive and the correct detection rate of CTA was 96.6%.One hundred sixty-five aneurysms identified by CTA were confirmed by DSA and the correct diagnostic rate of CTA was 96.5%.CTA failed to detect 6 aneurysms and mis-diagnosed 10 aneurysms.Conclusions The correct detection rate and diagnostic rate of CT angiography ( CTA) in multiple intracranial aneurysms is relatively high.But previous surgery, spasm of the vessels, the size and number of aneurysms, radiologists'experience can influence the accuracy of ( CTA) in the diagnosis of multiple intracranial aneurysms, indicating that we should combine CTA with DSA to avoid the misdiagnosis and missed diagnosis.

Downregulation of thioredoxin-interacting protein attenuates early brain injury after subarachnoid hem- orrhage of rats / 中国神经精神疾病杂志

Objective To explore the possible mechanism by which thioredoxin-interacting protein (TXNIP) par?ticipated in early brain injury (EBI) of subarachnoid hemorrhage (SAH) via examination of the expression of TXNIP and its downstream apoptotic factors before and after intervention. Methods Subarachnoid Hemorrhage (SAH) was performed by endovascular perforation. Total 97 adult male SD rats were randomly divided into 6 groups:sham-operation (17), SAH (32), control siRNA (12), TXNIP siRNA (12), resveratrol control (12) and resveratrol injection (12). Western blot was used to examine the expression of TXNIP, p-ASK-1, Caspase-3 before and after intervention. Laser scanning confocal microscopy (LSCM) was used to detect the expression of TXNIP in neurons. The co-localization of TXNIP with apoptotic cells was examined by using fluorescent TUNEL. Mortality, behavior score and cerebral edema were also evaluated. Re?sults Mortality, behavior scores and brain edema were improved after TXNIP siRNA and resveratrol injection(P<0.05). LSCM showed that TXNIP was widely expressed in brain and mainly located in cytoplasm of neurons in SAH rats. Fluo?rescent TUNEL revealed the co-localization of TXNIP with apoptotic cells. The expression level of TXNIP was signifi?cantly higher in SAH group than in sham operation (P<0.05, n=3). The expression level of TXNIP gradually increased at 12h and still remained at high level at 72h (P<0.05). This increase was simultaneously accompanied by the increase in downstream apoptosis factors, p-ASK-1 and Caspase-3. Inhibition of TXNIP by siRNA or resveratrol significantly re?duced the expression of TXNIP, p-ASK-1 and Caspase-3 (P<0.05, n=3). Conclusion TXNIP gradually increases in ear?ly period after SAH and aggravates brain damage through activation of ASK-1 apoptosis signaling pathway, whereas inhi?bition of TXNIP may attenuate EBI through reduction of p-ASK-1 and Caspase-3 after SAH.

Efficacy of therapeutic endoscopic retrograde cholangiopancreatography in treatment of acute obstructive suppurative cholangitis / 临床肝胆病杂志

ObjectiveTo investigate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute obstructive suppurative cholangitis (AOSC), and to examine the results of bile bacterial culture and drug susceptibility test. MethodsA retrospective analysis was performed on 150 AOSC patients who were admitted to the Fifth Affiliated Hospital of Zunyi Medical University from November 2009 to November 2014. All patients underwent ERCP. The bile of patients was collected during treatment. Antibiotics were chosen according to the results of bile bacterial culture and drug susceptibility test. The efficacy of ERCP was assessed. Comparison of continuous data between groups was made by independent-samples t test, while comparison of categorical data by chi-square test. ResultsThe rate of successful intubation was 92% (138/150), and the rate of effective drainage was 94.2% (130/138). After treatment, the 130 patients treated with effective drainage had significantly reduced total bilirubin and direct bilirubin (60.3±43.4 μmol/L vs 110.2±53.1 μmol/L, t=8.56, P＜0.05; 35.5±23.6 μmol/L vs 65.5±33.2 μmol/L, t=8.65, P＜0.05) and a significantly reduced percentage of neutrophils (65.2% vs 83.4%, χ2=11.85, P＜0.05). The results of bile bacterial culture showed that Gram-negative bacteria were found in 85.7% (78/91) of positive specimens. The β-lactam antibiotics with enzyme inhibitor could be used as the preferred drug, and carbapenems as second-line drugs. ConclusionECRP is a simple and effective therapy for AOSC. Antibiotics, chosen based on the results of bile bacterial culture, can quickly relieve symptoms of poisoning and prevent drug resistance.

Efficacy of therapeutic endoscopic retrograde cholangiopancreatography in treatment of acute obstructive suppurative cholangitis / 临床肝胆病杂志

ObjectiveTo investigate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute obstructive suppurative cholangitis (AOSC), and to examine the results of bile bacterial culture and drug susceptibility test. MethodsA retrospective analysis was performed on 150 AOSC patients who were admitted to the Fifth Affiliated Hospital of Zunyi Medical University from November 2009 to November 2014. All patients underwent ERCP. The bile of patients was collected during treatment. Antibiotics were chosen according to the results of bile bacterial culture and drug susceptibility test. The efficacy of ERCP was assessed. Comparison of continuous data between groups was made by independent-samples t test, while comparison of categorical data by chi-square test. ResultsThe rate of successful intubation was 92% (138/150), and the rate of effective drainage was 94.2% (130/138). After treatment, the 130 patients treated with effective drainage had significantly reduced total bilirubin and direct bilirubin (60.3±43.4 μmol/L vs 110.2±53.1 μmol/L, t=8.56, P＜0.05; 35.5±23.6 μmol/L vs 65.5±33.2 μmol/L, t=8.65, P＜0.05) and a significantly reduced percentage of neutrophils (65.2% vs 83.4%, χ2=11.85, P＜0.05). The results of bile bacterial culture showed that Gram-negative bacteria were found in 85.7% (78/91) of positive specimens. The β-lactam antibiotics with enzyme inhibitor could be used as the preferred drug, and carbapenems as second-line drugs. ConclusionECRP is a simple and effective therapy for AOSC. Antibiotics, chosen based on the results of bile bacterial culture, can quickly relieve symptoms of poisoning and prevent drug resistance.

The impacts of low-dose corticosteroids infusion given in different manners on refractory septic shock ;patients / 中华危重病急救医学

Objective To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock. Methods A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose ( MBG ) level, largest amplitude of glycemic excursions ( LAGE ), glucose variability ( GV ), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit ( ICU ) stay, total length of hospital stay, and 28-day mortality of both groups were recorded. Results Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [ mmHg ( 1 mmHg=0.133 kPa ):66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033 ], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine ( NE ) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group ( mmol/L:8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080 ), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [ LAGE ( mmol/L ): 17.18±8.97 vs. 22.71±11.80, t = 2.331, P = 0.022; GV ( mmol/L ): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036;the ratio of hyperglycemia time:( 43.1±11.7 )%vs. ( 49.4±15.3 )%, t=2.044, P=0.044 ]. There was no statistical difference in the following features between research group and control group, such as the duration of shock ( days:3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547 ), length of ICU stay ( days:8.74±3.12 vs. 9.97±3.37, t = 1.543, P = 0.120 ), total length of hospital stay ( days: 18.34±9.27 vs. 19.58±9.83, t = 0.576, P = 0.566 ) and 28-day mortality rate ( 23.68%vs. 26.83%,χ2=0.103, P=0.748 ). Conclusions Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.

Analysis on prognostic related factors of surgical treatment in patients with ruptured intracranial aneurysm and their clinical significance / 重庆医学

Objective To investigate the prognostic related factors in the patients with ruptured intracranial aneurysm treated by surgical treatment and their clinical significance .Methods The medical record data in 218 cases of ruptured aneurysm treated by operative treatment were performed the retrospective analysis ,including th egeneral data ,Hunt‐Hess grade on admission ,surgical procedure ,etc .The patient′s prognosis situation adopted the Glasgow outcome scale(GOS) as the evaluation standard when dis‐charge from hospital .Firstly the possible factors were performed the single factor analysis ,then the factors with statistic signifi‐cance in the single factor analysis were performed the multiple factors logistic regression analysis .Results The single factor analy‐sis indicated that the age ,Hunt‐Hess grade on admission ,hypertension ,operation mode ,CT Fisher grading and symptomatic vaso‐spasm were significantly correlated with the prognosis ( P < 0 .05) .The multiple factors analysis indicated that age ,Hunt‐Hess grade on admission ,symptomatic vasospasm ,CT Fisher grading were the independent risk factors affecting the prognosis of patients (P< 0 .05) .Conclusion The patients′ age ,Hunt‐Hess grade on admission ,symptomatic vasospasm and CT Fisher grading can sig‐nificantly affect the prognosis of the patients with ruptured intracranial aneurysm after surgical treatment .Paying attention to the predictive value of these predictors has important clinical significance to reduce the postoperative mortality rate and disability rate in the patients with ruptured intracranial aneurysm .

Expression of Hepcidin in rats after subarachnoid hemorrhage / 中国神经精神疾病杂志

Objective To examine the iron content and the expression of hepcidin in early period after subarach-noid hemorrhage (SAH) in rats, and to explore the role of hepcidin in dysregulation of brain iron metabolism after SAH. Methods Totally 90 adult male SD rats were randomly divided into two groups:the sham-operation group and SAH group. The SAH model was established by single blood injection to prechiasmatic cistern. Immunohistochemical and Western Blotting were used to examine the expression of hepcidin at 12, 24, 48 and 72h after SAH. Meanwhile, Atomic Absorption Spectrometer was used to detect the iron content. Results Immunochemistry showed that hepcidin expression in rats in SAH group began to rise at 12 h(0.30±0.06)and gradually increased over time until 72 h(0.56±0.07)compared with the sham group(0.19±0.05). The expression of hepcidin was significantly higher in SAH group than in the sham group(F=31.911, P<0.05). Western blot showed that hepcidin expression in rats in SAH group began to rise at 12h(0.481±0.065) and gradually increased over time until 72h(1.627±0.143)Compared with the sham group(0.238±0.047). The expression of hepcidin was significantly higher in SAH group than in the sham group after SAH(F=147.314,P<0.05). Iron content in SAH group began to rise at 12h after SAH(58.50±9.19)and gradually increased until 72 h(99.34±7.68). The iron con-tents in SAH group were higher at every time points than those in sham group(43.51±4.59)(F=28.799,P﹤0.05). The ex-pression of hepcidin was correlated with the iron content in SAH group(r=0.914,P﹤0.01). Conclusion The increase in iron content following SAH is associated with the increased hepcidin expression.

Blocking p38 signal pathway lowers MMP-9 expression and reduces brain edema in rats with traumatic brain injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the role of p38 signal pathway in regulating matrix metalloproteinase-9 (MMP-9) expression and brain edema formation in a rat model of traumatic brain injury (TBI).</p><p><b>METHODS</b>A total of 130 adult male Sprague Dawley rats were randomly divided into 4 groups, namely the normal group (n=10), sham-operated group (n=40), TBI (induced by Feeney free falling methods) group (n=40), and SB group with intraperitoneal SB203580 treatment (10 µmol/L) 15 min before TBI (n=40). The rats were sacrificed 2 h and 2 days after TBI. The expressions of p38, p-p38, and MMP-9 mRNA and protein were detected by RT-PCR and Western blotting. The blood brain barrier permeability was detected by Evans Blue (EB) test, and the brain water content (BWC) was determined using a gravimetric technique.</p><p><b>RESULTS</b>The expression of p-p38 protein increased markedly 2 h after TBI (P<0.05), and was suppressed by SB203580 treatment (P<0.05). MMP-9 mRNA and protein showed no obvious increase at 2 h after TBI, but significantly increased at 2 days as compared with those in the sham-operated group (P<0.05). MMP-9 mRNA and protein were much lower in SB group than in TBI group 2 days after TBI (P<0.05). The blood brain barrier permeability significantly increased 2 h after TBI (P<0.05) and kept increasing until 2 days (P<0.05), but was reduced significantly by SB203580 (P<0.05). BWC increased obviously 2 days after TBI (P<0.05) and was lessened by SB203580 (P<0.05).</p><p><b>CONCLUSION</b>Blocking p38 signal pathway can attenuate MMP-9 upregulation and brain edema after TBI, suggesting the important role of p38 in regulating MMP-9 expression to affect traumatic brain edema.</p>

Treatment of upper urinary calculi with MPCNL : experience of 10,452 cases of 19 years in a single-center / 中华泌尿外科杂志

Objective　To analyze the clinical indications,efficacy and safety of Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi based on our experience.Methods　From June 1992 to September 2010,a total of 10,452 patients (6060 males and 4392 females)with a mean age of (47.6 ± 13.7) years (7 months-93 years) received MPCNL in our center.The mean stone burden was (777.4 ± 740.3) mm2 (20 - 4 080 mm2 ).The data of stone burden,operative techniques,operating time,stone-free rate,major complication,hospital stay and stone composition were investigated.　Results　Of the 10 452 cases,11 801 procedures were performed on 10 876 (5493 left and 5383right) renal units,including 10 102 first stage procedures,1604 secondary procedures,86 third procedures and 9 fourth procedures.There were 11 830 tracts established,including 373 (3.15％ ) tracts of 14 F,7867 (66.50％) tracts of 16 F and 3590 (30.35％) tracts of 18 F.There were 1207 (10.20％),9174(77.55％) and 1449 (12.25％) punctures located in upper,middle and lower pole,respectively.956(8.79％) renal units were managed with multiple tracts,which including 2 tracts in 846 (7.78％) units,3tracts in 85 (0.78％) units,4 tracts in 18 (0.17％) units and 5 tracts in 7 (0.06％) units.Pneumatic lithotripsy was used in 8563 (72.56％) procedures,Holmium:YAG laser lithotripsy was used in 2981(25.26％)　procedures and Pneumatic lithotripsy + Holmium: YAG laser lithotripsy was used in 257(2.18％) procedures.762 (7.29％) cases needed ESWL to clean the stone after MPCNL.The average operating time was ( 101.3 ± 44.2) min ( 10 -240 min).The stone-free rate of MPCNL was 89.9％,which increased to 93％ by adjunctive ESWL.And the mean hospital stay was ( 13.2 ± 6.4) days (2 - 72 days).The major complications happened on 321 (3.07％) cases,including 294 (2.81％ ) cases of blood transfusion,12 (0.11％ ) cases of sepsis,2 (0.02％) cases of renal abscess,9 (0.09％) cases of pleura injury,2 (0.02％) cases of colon injury and 2 (0.02％) cases of death.53 (0.51％) cases needed selective renal arterial embolization to achieve hemostasis.The main stone compositions were analyzed in 4345 cases.Calcium oxalate,calcium phosphate,magnesium ammonium phosphate,uric acid,ammonium urate,carbapatite and cystin were 91.74％,90.33％,14.91％,17.77％,4.83％,8.47％ and 0.51％,respectively. Conclusions　MPCNL is an effective and safe treatment option for all kinds of upper urinary calculi in patients at all ages with a high stone free rate and low major complication rate.

Optimization of preparation parameters for gentamicin-loaded PLLA nanoparticles and the drug release behavior in vitro / 生物医学工程学杂志

It has been one of important issues in nanomedicine research field to prepare drug-loaded nanoparticles. Optimization of the preparation parameters plays a key role in obtaining drug-loaded nanoparticles with homogeneous particle size and controlled drug release property. In this paper, gentamicin-loaded PLLA nanoparticles was prepared by means of double emulsion and solvent evaporation technique. Statistical software SPSS was employed to deal with the orthogonal design for optimizing the parameters of the formulation. The in vitro release of gentamicin from nanoparticles was determined by ultra-violet spectroscopy. Analysis of the experimental data based on orthogonal design demonstrated that the concentration of PLLA solution and the molecular weight of PLLA had significant influence on the size of nanoparticles, and the ratio of oil phase to water phase exhibited determined role in the gentamicin release property. Gentamicin-loaded PLLA nanoparticles prepared with the optimized parameters showed homogeneous particle size of 277 nm and sustained release property, which displayed a promising potential of clinical applications.

Endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys / 中华泌尿外科杂志

Objective To report the clinical outcomes of applying endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys. Methods Between February 2001 and April 2008, 13 men and 5 women with ureterovesical anastomotic site obstruction in their transplanted kidneys were treated by endoscopic incision with electrocautery or holmium: YAG laser. After the anastomosis was completely resected, two Double-J stents were placed in the ureter for 6-8 weeks. During follow-up, renal function, ultrasound examination and wash-out renal scintig-raphy were performed every month for the first 6 months, then every 3 months. Results Total 25 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. No complication was recorded during or after the procedure. At the mean follow-up of 51 months (range 4-90 months), 5 patients presented with recurred obstructive uropathy immediately after the Double-J stent removal and finally underwent open surgical correction. Conclusions Endo-scopic incision is safe and effective in the treatment of ureterovesical anastomosis site obstruction in transplanted kidney. However, open surgical reconstruction should be considered if endoscopic inci-sion procedure has failed.

Expression changes of Tau protein in retinal ganglion cells and oligodendrocytes following axonal injury in rats / 中华创伤杂志

Objective To investigate expression changes of Tau protein in retinal ganglion cells (RGCs) and oligodendrocytes (Ols) after stretch injury in rats and explore the relationship of Tau protein with pathological changes after axonal injury. Methods Morphological changes of optic nerves, RGCs and OLs after stretch injury were examined under light microscope in control group, stretch only group, heat stress only group and heat stress pretreatment plus stretch group. The expressions of Tau protein in RGCs and OLs after heat stress and/or stretch injury were observed by using immunohistechemical stai-ning. Results Pathological changes of axons, RGCs and OLs were identified morphologically or quan-titatively after stretch injury to the optic nerves, which was significantly ameliorated through pretreatment with heat stress plus stretch injury. The expressions of Tau protein in RGCs and OLs were increased in stretch only group. There was no significant expression change of Tau protein in heat stress only group. Expression of Tan protein was obviously decreased in heat stress pretreatment plus stretch group. Con-clusions Both neurons and glial cells are involved in pathological process after axonal injury. The ex-pression changes of Tau protein are probably related to delayed axotomy and neuron apoptosis. Heat stress can relieve the impairment of cystoskeleton through decreasing and delaying the expression of Tau protein.

Clinical comparison of therapeutic methods for calculi in congenital anomalous kidneys / 中华泌尿外科杂志

Objective To evaluate the therapeutic methods for stones in congenital anomalous kidneys. Methods The clinical outcomes of 126 patients(75 males and 51 females: mean age 39 years, range 12-66 years)who underwent extracorporeal shock wave lithotripsy (ESWL, n= 37), minimally invasive percutaneous nephrolithotomy (MPCNL, n = 41) or open surgery (n = 48) were retrospectively reviewed. There were 40 horseshoe kidneys(31.8%), 51 duplex kidneys(40.5%), 35 malrotated kidneys(27.8%). Seventyl calculi were located in left kidneys(55.6%)and 56 in right kid-neys(44.4%). There were 96 single stones(76.2%)and 30 complex stones(23.8%). The greatest di-ameter of stone ranged from0.8 cm to 2.2 cm(mean 1.5 cm) in ESWL group, 1.0 cm to 4.0 cm (mean 2.5 cm) in MPCNL group and 1.5 cm to 3.8 cm(mean 2.7 cm) in open surgery group. The therapeutic effects of 3 methods were compared. Results The stone-free rate at 1 session was 78.4%(29/31) in ESWL group, 85.4%(35/41) in MPCNL group and 87.5%(42/48) in open sur-gery group. No significant difference was found among the 3 groups(x2 = 1.39,P=0.50). The inci-dence of complications was 13.5% in ESWL group, 9.7% in MPCNL group and 6.3% in open sur-gery group(x2=1.28, P=0.53). Only 1 case of malrotated kidney suffered massive hemorrhage and was cured by selective embolism of renal artery. No major complications occurred in the other pa-tients. Conclusions With rigorous indication, ESWL or MPCNL is as safe and effective as open sur-gery in the management of stones in congenital anomalous kidneys. It should be considered as the pri-mary therapy. But the treatment must be individualized in terms of the type anomalous kidney, stone characteristics and obstruction.

A clinical study on brain herniation in patients with moderate craniocerebral injury during subacute phase after truma / 重庆医科大学学报

Objective:To summrize the clinical features of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma and to study the etiology.Methods:The data of 33 cases of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma in the department where the authers worked from 1997 to 2005 were studied retrospectively.Results:Hematoma formation after cerebral contusion,cerebral edema after cerebral contusion,delayed intracerebral hematomas formation were main causes of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma.There were 28 patients had been treated surgically after exacerbation.22 cases had a good prognosis and 5 cases died of cerebellar tonsillar herniation.Conclusion:The conditon of most patients with moderate craniocerebral injury during subacute phase after truma is stable,while some cases worsen and even develop into brain herniation,and the incidence of disablity and mortality rise significantly.

Preliminary Discussion of Teaching Neurosurgery in English to Foreign Students / 中华医学教育探索杂志

Attentions have been paid to teaching Nepal students in English in our university,and many problems need to be analyzed and solved.Selection and application of appropriate teaching material,sufficient preparation before class and applying nimble teaching style have received satisfactory results.