Research progress on mechanism of biotrauma caused by ventilation-induced lung injury / 中华危重病急救医学

Mechanical ventilation is an advanced life support treatment for patients with acute respiratory failure. While stabilizing respiratory function, it also acts as an injury factor to exacerbate or lead to lung injury, that is, ventilation-induced lung injury (VILI). There may be a more subtle form of damage to VILI known as "biotrauma". However, the mechanism of biotrauma in VILI is still unclear. This article intends to review the mechanism of biotrauma of VILI from the aspects of inflammatory response, oxidative stress and complement activation, in order to provide a new strategy for clinical prevention and treatment of biotrauma caused by VILI.

Role of innate immunity in the pathogenesis of ventilation-induced lung injury / 中华危重病急救医学

For patients receiving mechanical ventilation, mechanical ventilation is also an injury factor at the same time of treatment, which can lead to or aggravate lung injury, that is, ventilator-induced lung injury (VILI). The typical feature of VILI is that the mechanical stress is transmitted to cells through the pathway, leading to uncontrollable inflammatory cascade reaction, which causes the activation of inflammatory cells in the lung and the release of a large number of cytokines and inflammatory mediators. Among them, innate immunity is also involved in the occurrence and development of VILI. A large number of studies have shown that damaged lung tissue in VILI can regulate inflammatory response by releasing a large number of damage associated molecular pattern (DAMP). Pattern recognition receptor (PRR) participates in the activation of immune response by combining with DAMP, and releases a large number of inflammatory mediators to promote the occurrence and development of VILI. Recent studies have shown that inhibition of DAMP/PRR signaling pathway can play a protective role in VILI. Therefore, this article will mainly discuss the potential role of blocking DAMP/PRR signal pathway in VILI, and provide new ideas for the treatment of VILI.

Comparison of Intraoperative Ultrasound-guided Versus Technique Modified Subclavian Vein Puncture During Implantation of Totally Implanted Port / 肿瘤防治研究

Objective To compare the success rate and complication rate between real-time ultrasound-guided and technique modified methods of right subclavian vein puncture in tumor patients during implantation of totally implanted port, and to evaluate their effectiveness and safety. Methods We randomly divided 260 tumor patients into ultrasound-guided group and technique modified group, and compared the success rate, pneumothorax, arterial injury, ectopic catheter, local hematoma, puncture times, pinch-off syndrome, etc. Results The success rate of primary puncture in the ultrasound-guided group was better than that in the technique modified group (96.92% vs. 86.15%, P=0.002). The overall complication of the ultrasound-guided group was lower than that of the technique modified group (0 vs. 9.23%, P < 0.001). The incidence of pneumothorax (0 vs. 3.85%, P=0.024) and accidental arterial injury (0 vs. 3.08%, P=0.044) in the ultrasound-guided group were lower than those in the technique modified group. There was no arteriovenous fistula and pinch-off syndrome in any group. Conclusion Compared with the technique modified group, the ultrasound-guided group has more advantages in puncture. Patients with vascular variability can be detected in time.

Research progress of spontaneous respiration in mechanical ventilation of acute respiratory distress syndrome / 中华危重病急救医学

Mechanical ventilation is an important supportive treatment for acute respiratory distress syndrome (ARDS). However, improper mechanical ventilation can cause a "second hit" to the lung, that is, ventilator-induced lung injury (VILI), characterized by translocation of pulmonary inflammatory mediators into the bloodstream, aggravating systemic inflammatory response syndrome, and multiple organ failure. Although the current protective mechanical ventilation strategy plays an important role in supporting treatment, the mortality of ARDS with mechanical ventilation is still very high. Therefore, to explore the strategy of pulmonary protective ventilation has always been the key orientation of ARDS and has important clinical significance. This article reviews the application, advantages and disadvantages of assisted and non-assisted spontaneous respiration in ARDS patients undergoing mechanical ventilation, in order to provide a reference for research and development of new strategies for ARDS protective ventilation.

Dermatomyositis with exfoliation of esophageal mucosa: A case report / 中南大学学报(医学版)

Dermatomyositis (DM) is a kind of idiopathic inflammatory myopathy characterized by chronic proximal skeletal muscle weakness and unique skin lesions. However, DM with exfoliation of esophageal mucosa is rare. A 36-year-old male patient complained of muscular soreness of extremities, dysphagia, and pharyngalgia was diagnosed with DM with exfoliation of esophageal mucosa. After treatment with glucocorticoid, immunosuppressant, acupuncture, and endoscopic submucosal dissection (ESD), the above symptoms were disappeared. During the 3-year follow-up period, the results of routine physical examination, laboratory examination, gastroscopy, and imaging examination were normal. High-dose of corticosteroid is needed in the initial treatment, but it must be reduced regularly to avoid adverse reactions. Acupuncture and ESD are also effective as adjuvant therapy.

A review of studies on the pathogenesis and preclinical drug therapy of acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) is a serious disease with high mortality, which is characterized by non-cardiogenic pulmonary edema and hypoxemia. In recent years, the development of supportive therapy has reduced the mortality to some extent, however, the high cost of treatment, side effects and the high mortality of moderate and severe ARDS limit its efficacy. So it is necessary to strengthen the research on specific drugs. The core pathological changes of ARDS are the uncontrolled inflammatory response and the impairment of pulmonary vascular endothelium and alveolar epithelial barrier function. Therefore, regulating the intensity of inflammatory response and promoting the endothelial and epithelial barrier have become two key factors in the current drug treatment of ARDS. This article summarizes the pathogenesis of ARDS and the related preclinical drug therapy of ARDS in recent years from two aspects: the uncontrolled inflammatory response and the destruction of alveolar epithelial and pulmonary vascular endothelial barrier, in order to provide reference for the later treatment of ARDS.

Effect of three-dimensional conformal radiotherapy with conventional radiotherapy combined TACE treatment on patients with primary liver cance r / 中国医学装备

Objective:To analyze the effect of three-dimensional conformal radiotherapy with conventional radiotherapy combined TACE treatment on patients with primary liver cancer. Methods: To choose patients with primary liver cancer in our hospital as research object, randomized to control group patients received conventional radiotherapy combined with TACE and observation group received three-dimensional conformal radiotherapy combined with TACE, compared therapeutic effect, IGF-Ⅱ, IGFBP-2 and AFP levels, progression-free survival and overall survival.Results: 1)observation group patients’ CR,PR rate after treatment was significantly higher than control group patients; 2)observation group patients’ IGF-Ⅱ, IGFBP-2 and AFP levels after treatment were significantly lower than control group patients; 3) observation group patients’ survival and overall survival time after treatment were significantly longer than control patients(t=5.325,t=6.924;P<0.05).Conclusion: Three-dimensional conformal radiotherapy combined with TACE help improve treatment of patients with primary liver cancer, reduce the level of indicators related to blood cancer and prolong survival time, with positive clinical significance.

A 20-year follow-up study on the correlation between long-term chronic pharyngitis and rheumatic heart vavular disease caused by latent chronic rheumatic activity / 中华风湿病学杂志

Objective To observe the correlation between long-term chronic pharyngitis and rheumatic heart vavular disease (RHD) caused by to long-term latent chronic rheumatic activity and to understand the progressive course of rheumatic heart vavular disease. Methods In 1126 cases with chronic pharyngitis, 319 cases with serum antistreptolysin O (ASO) level between 400-500 U/ml were followed-up. ASO, creatine kinase enzyme MB (CK-MB) and echocardiography were measured for follow-up since 1986. Of the 319 cases, 158 were male and 161 were female with the average age of 29.4 years old. By the end of 2009, 6 cases were lost during follow up, data of 313 cases including 155 male patients and 158 female patients whose average age was 49.6 were analyzed. As the number of every kind of rheumatic heart vavular lesion was so fewer for statistical analysis that the data were only listed in tables. The student's t test was performed to compare of the ASO, CK-MB between the group with vavular lesionss and the group without vavular lesion. Results ①Of the 313 cases, 9 cases suffered from rheumatic fever at the fourth year since 1986, and 29 cases had rheumatic fever 1, 2 or 3 years after the ASOs decreased to lower than 400 U/ml and no one developed heart valvular lesion.②Two hundred and seventy-five cases whose ASO in the range of 400-500 U/ml but with normal CK-MB were found by the end of 5, 10, 15, 20 years, 9, 42, 65, 78 cases had developed heart vavular diseases respectively. ③ The levels of CK-MB in the heart valvular disease groups were significantly higher than those in the non-vavular disease group, while the levels of ASO were not. Conclusion Some of the cases suffering from long-term chronic pharyngitis can have high levels of ASO, but with normal CK-MB. These patients may have latent long-term chronic rheumatic activity and develop rheumatic heart valvular disease years later.