"The rat acute lung injury method of oleic acid ""two strike""" / 中华胸心血管外科杂志

Objective To explore the method of oleic acid two strike to build a better clinical pathophysiology of acute lung injury animal model state.Methods The 60 male and healthy Sprague-Dawley rats, weighing 180 ～ 220g.According to the time of purchase.No.1, 2, 3 The order No.60, Each number, were randomly divided into 3 groups: normal control group(20 rats) : intravenous injection of normal saline 0.07ml/kg, an hour after intravenous injection of saline 0.03 ml/kg.The traditional group(20 rats) : intravenous injection of oleic acid 0.l ml/kg.The model group(20 rats) : intravenous injection of oleic acid 0.07 ml/kg, one hour after intravenous injection of oleic acid 0.03 ml/kg.Close observation of vital signs of breathing and Hemodynamicsin rats.Stable operation of 30 min, Each operation is stable after 30 minutes of measuring arterial blood gas, lung water content, the change degree evaluation of early lung injury of lung tissue pathology.Through the analysis of arterial blood gas, lung water content, HE stained pathological changes of lung tissue in Smith scoring method to determine the degree of lung injury in rats, to evaluate whether the model was successfully established.Results There are 5 rats died after a sharp drop in blood pressure of oleic acid used in traditional group rats, the changes of hemodynamics of traditional group compared with model group were severe, especially in the 5 ～ 30min after injection of oleic acid.The model group was no death, intravenous injection of oleic acid(0.1 ml/kg) from 7 to 8 min after respiratory frequency rats increased gradually, difficulty in breathing, endotracheal see pink frothy sputum.After 1 h pumping and arterial blood gas results showed that pH (7.17 ± 0.15) PaO2, (41.85 ± 8.16) mmHg was significantly lower than that of normal group(P ＜ 0.01) , oxygenation index (PaO2/FiO2) ≤ 300 mmHg, met the diagnostic criteria of acute lung injury, the moisture content(P ＜ 0.05), according to the Smith score, pathological model group compared with normal group significantly increased(P ＜ 0.01).Conclusion Two hit the body can produce severe inflammatory reaction of lung and lasting, build a close clinical pathophysiology of acute lung injury animal model successfully state.Meet the pathophysiological clinical change of acute lung injury, and can be used for basic and clinical research of acute lung injury in infants.

Diagnosis and treatment of patients with esophageal perforation and rupture / 中华全科医师杂志

We retrospectively analyzed the clinical data of 17 patients with esophageal perforation and rupture from August 2007 to December 2011.Among them,there were spontaneous esophageal rupture (n =6),esophageal perforation caused by foreign bodies (n =8) and iatrogenic injury (n =3).Family members gave up treatment because of critical illness (n =2),conservative treatment was offered for surgical intolerance (n =1) and all others (n =14) underwent operation (thoractomy,n =13 ; neck incision,n =1).One patient with conservative treatment and another two surgical cases died.The other 12 cases recovered.Therefore individualized treatment is essential for the patients with esophageal perforation and rupture.

Study of implantation dynamics and discipline in unrelated double umbilical cord blood transplantation / 白血病·淋巴瘤

[Objective]To study the discipline of implantation and implantation dynamics in unrelated double umbilical cord blood transplantation(DUCBT).[Methods]Twenty-nine patients with hematologic malignancies who undergoing two-units unrelated donor cord blood transplantation were included in the study.After transplantation,hematopoietic chimerism of peripheral blood was evaluated by the Results of short tandem repeat with polymerase chain reactions(STR-PCR)which quantitatively determinated 16 specific alleles between donor and receptor, to find out their chimerism dynamic change, to judge whether transplantation was implanted and judge which one was implanted,and to study the discipline of implantation in DUCBT.At the same time,total nucleated cells(TNC),dose of CD34 cells,colony forming unit(CFU),colony forming unit-granulocyte and macrophage(CFU-GM),dose of CD; cells,dose of natural killer(NK)cells were compared between dominant units and non-dominant ones,to quest the discipline implantation dynamics of DUCBT.[Results]In 29 clinical cases,23 cases obtained engraftment,including 22 cases appearing one unit cord blood engraftment and 1 case appearing two units cord blood engraftment.Of 22cases with one dominant unit engraftment,at 14 days after DUCBT,the results of STR-PCR showed that 20cases appeared one dominant unit engraftment,other 2 cases appeared one dominant unit engraftment at 21days after DUCBT.Of 6 cases without engraftment,at 14 days after DUCBT,2 cases showed chimerism of two units cord blood,other 4 cases showed chimerism of two units cord blood or one unit cord mixed with receptor.At 30 days after DUCBT,their STR-PCR results of bone marrow showed full donor chimerism.Compared results at day 7,day 14,day 21 by peripheral blood,and day 30 by bone marrow with results of implantation after DUCBT,their coherence were kappa=0.112,P=0.198,kappa =0.811,P =0.001,kappa =0.900,P =0.001 and kappa =0.900,P =0.001,respectively.In addition,compared dominant unit with nondominant unit,TNC,doses of CD+34 cells,CFU,CFU-GM,CD; cells and NK cells were all no significant difference between them (P=0.783,0.455,0.615,0.534,0.114,0.463,respectively).[Conclusion]STR-PCR which quantitatively determinates 16 specific alleles between donor and receptor is sensitively and specifically to judge implant status.The 14 days after DUCBT was the time when implant is embedded.However,the implantation dynamics of DUCBT is still unknown which need further quest in the future.

Reconstruction of pulmonary artery by autologous pericardium or azygous venae for non-small cell lung cancer / 中华胸心血管外科杂志

Objective To review the clinical experience of reconstruction of pulmonary artery(PA) by a pateh of autologus pericardium or azygous venae for non-small cell lung cancer. Methods Between March 1992 and August 2009, 62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA. According to PTNM classification, 4 patients were in stage Ⅱb, 46 in stage Ⅲa and 12 in stage Ⅲb. 17 patients had induction chemothoerapy. Sleeve lotrate the PA, the surgical procedures included partial PA tangential resections and reconstructions by a pateh of autologous azygous venas in 18 cases , a patch of autologous pericardium in 38 cases and a complete PA sleeve resection reconstructios by a custom-made autologous pericardial conduit interposition in 6 cases. Partial superior vena cava tangential resctions and reconstructions were performed in 5 patients by a patch of autologous pericardium or azygous venae. 47 patients received pstoperative chemotherapy and 19 had radiotherapy. Results There was 2 early postoperative deaths(3.2%). The cause of death was bronchial anastomotic leak led to respiratory failure in 1 case and severe arrhmia led to heart arrest in 1. No cancerous tissue of all resection margins are checked by frzen section histology and examination of resection specimens in the surgical pathology laboratory. The postoperative complications occurred in 11 patients(17.7%) and all of them recovered uneventfully.Roentgenography, flexible bronchoscopy and echocardiography were in normal range in the remaining 60 patients with no bronchial anastomosis stenosis or vascular thombosis before discharge and at 2-6 months after surgery. The mean follow up time was 49.5 months (6-210 months). The overall 1, 3, 5 and 10 yerr survival rates were 80.2%, 44.7% ,31.4% and 23. 1%, respectively. Conclusion Reonstruction of PA by autologous pericardial patch or autologous azygos vein patch is a safe and effective technique for locally advanced lung cancer.For extended circumferential defects of PA,the autologous pericardial conduit interposition could bue used for reconstruction.

Clinical study of unrelated cord blood transplantation in patients with hematologic malignancies in single center / 中华器官移植杂志

Objective To retrospectively analyze the engraftment, transplant-related complications and survival after unrelated cord blood transplantation (UCBT) in patients with hematologic malignancies. Methods Fifty consecutive patients with hematological malignancies (median age, 19 years; median weight, 53 kg) were treated with UCBT in single center from April 2000 to August 2009. Thirty-nine patients were high-risk or refractory. Double UCB grafts were used for 26 patients, while single UCB graft for 24 patients. Myeloablative conditioning was given to 45 cases and non-myeloablative regimens to 5 cases. All patients were given a combination of cyclosporin A (CsA) and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. Results The median total nucleated cell (TNC) dose was 4.0 (range, 1.95-16.24)×10~7 TNC/ kginfused, and CD34~+ cell dose was 2.74(range, 0.67-29.28)×10~5/kginfused. Forty-two of 50 patients acquired engraftment with implantation rate being 86%. The median time to engraftment (absolute neutrophil count>500/mm~3 and platelets 20 000/L) was 19 and 34 days. The cumulative incidence of neutrophil engraftment by day 42 was 86.3%(95% confidence interval [CI] 0.769-0.957); the cumulative incidence of platelets engraftment by day 120 was 72.3% (95% CI 0.620-0.821). Twenty cases developed acute GVHD, and the incidence of acute GVHD of grades Ⅲ/Ⅳ by day 100 was 7.1%. The incidence of chronic GVHD within 2 years was 17.4%. During a median follow-up period of 22 months (range 4-116), Overall 6-month, 1-year and 2-year survival rate was 66.2%(95% CI 0.590-0.734), 57.4%(95% CI 0.496-0.652), 54.2%(95% CI 0.462-0.622), respectively. For the patients with non-advanced hemotologic malignancies, 6-month, 1-year and 2-year survival rate was 73.2% (95% CI 0.659-0.805), 66.1% (95% CI 0.579-0.743), and 62.2% (95% CI 0.542-0.682) respectively. Five cases relapsed. The cumulative incidence of relapse within 2 years was 16.2% (95% CI 0.099-0.225). Twenty-one cases died mainly due to infection. Conclusion UCBT could be safely and effectively used for adult patients with hematologic malignancies.

Simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in right ventricular outflow tract reconstruction / 中华胸心血管外科杂志

Ovbective To evaluate the clinical results of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in right ventricular outflow tract(RVOT)reconstruction. Methods From Jan.2003 to Jan.2004,Twenty-five patients who have complex congenital heart anomalies with pulmonary artery hypoplasia received surgical correction with RVOT reconstruction were randomly divided into research group (n=13) and control group (n=12). The patients in the research group used the technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium,routine technique of a transannular patch with or without a autologus pericardial monocuspid valve was used in control group. The main clinical characteristics and follow up data were studied and compared. The degree of pulmonary insufficiency was evaluated before discharge,at 3～6 months,and at 12months after the operation. Results There was no operative mortality in two groups. Compared with control group,the mean right ventricle to left ventricle systolic pressure ratio,right atrial pressure,maximum doses of dopamine and correction of pulmonary insufficiency were improved significantly (P

Treatment of two case childhood acute lymphoblastic leukemia by HLA-mismatched unrelated umbilical cord blood transplantation / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the hematopoietic and immunologic reconstitution and transplantation-related complications of HLA one locus mismatched unrelated umbilical cord blood transplantation for the treatment of hematological malignancies.</p><p><b>METHODS</b>Two children with acute lymphoblastic leukemia received HLA-mismatched unrelated umbilical cord blood transplantation. The conditioning regimens were BU-CTX (case 1) and BU-CTX plus BCNU (case 2). GVHD prophylaxis regimen consisted of cyclosporine (CsA) and mycophenolate mofetil (MMF). The patients received 14.6 x 10(7) nucleated cells/kg with 7.24 x 10(5) CD(34)(+) cells/kg and 16.24 x 10(7) nucleated cells/kg with 21.11 x 10(5) CD(34)(+) cells/kg, respectively.</p><p><b>RESULTS</b>The two recipients, ANC > 0.5 x 10(9)/L occurred at day 27 and day 17, BPC > 50 x 10(9)/L at day 53 and day 46, the peripheral blood counts normalization at day 60 and day 52, the immune function normalization at day 134 and day 122 and the DNA fingerprinting showing engraftment at day 19 and day 17, respectively. The donor-recipient pair of case 1 was male to female, and the chromosome karyotype of recipients bone marrow and peripheral blood cells showed 100%, 46, XY cells at day 49. Grade II acute graft versus host disease (aGVHD) occurred at day 26 (case 1) and day 21 (case 2). The two recipients have survived for 353 days and 256 days.</p><p><b>CONCLUSION</b>The hematopoietic and immunologic reconstitution in umbilical cord blood transplantation were earlier and more durable. The transplantation-related complications were less and aGVHD were milder.</p>