Simulated aeromedical evacuation exacerbates burn induced lung injury: targeting mitochondrial DNA for reversal.

BACKGROUND: Aeromedical evacuation of patients with burn trauma is an important transport method in times of peace and war, during which patients are exposed to prolonged periods of hypobaric hypoxia; however, the effects of such exposure on burn injuries, particularly on burn-induced lung injuries, are largely unexplored. This study aimed to determine the effects of hypobaric hypoxia on burn-induced lung injuries and to investigate the underlying mechanism using a rat burn model. METHODS: A total of 40 male Wistar rats were randomly divided into four groups (10 in each group): sham burn (SB) group, burn in normoxia condition (BN) group, burn in hypoxia condition (BH) group, and burn in hypoxia condition with treatment intervention (BHD) group. Rats with 30% total body surface area burns were exposed to hypobaric hypoxia (2000 m altitude simulation) or normoxia conditions for 4 h. Deoxyribonuclease I (DNase I) was administered systemically as a treatment intervention. Systemic inflammatory mediator and mitochondrial deoxyribonucleic acid (mtDNA) levels were determined. A histopathological evaluation was performed and the acute lung injury (ALI) score was determined. Malonaldehyde (MDA) content, myeloperoxidase (MPO) activity, and the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome level were determined in lung tissues. Data among groups were compared using analysis of variance followed by Tukey's test post hoc analysis. RESULTS: Burns resulted in a remarkably higher level of systemic inflammatory cytokines and mtDNA release, which was further heightened by hypobaric hypoxia exposure (P < 0.01). Moreover, hypobaric hypoxia exposure gave rise to increased NLRP3 inflammasome expression, MDA content, and MPO activity in the lung (P < 0.05 or P < 0.01). Burn-induced lung injuries were exacerbated, as shown by the histopathological evaluation and ALI score (P < 0.01). Administration of DNase I markedly reduced mtDNA release and systemic inflammatory cytokine production. Furthermore, the NLRP3 inflammasome level in lung tissues was decreased and burn-induced lung injury was ameliorated (P < 0.01). CONCLUSIONS: Our results suggested that simulated aeromedical evacuation further increased burn-induced mtDNA release and exacerbated burn-induced inflammation and lung injury. DNase I reduced the release of mtDNA, limited mtDNA-induced systemic inflammation, and ameliorated burn-induced ALI. The intervening mtDNA level is thus a potential target to protect from burn-induced lung injury during aeromedical conditions and provides safer air evacuations for severely burned patients.

[Analysis and prevention of postoperative complications of tubularized incised plate urethroplasty for hypospadia].

OBJECTIVE: To explore the reasons and preventions of complications of tubularized incised plate urethroplasty technique for hypospadia repair. METHODS: In the study, 54 patients of 247 hypospadia patients were analyzed who had complications, using SPSS 13.0 statistics to compare their complications with anatomy reasons including positions of the meatus, development of urethral mucous membrane and glans penis and degrees of ventral curvature. RESULTS: (1) Postoperative complications were relative to the position of meatus. The closer urinary meatus was to the coronary sulcus, the higher complication rate would be(χ(2)=26.309, P<0.01).( 2) The complication rate of normal glans penis was lower than that of the small glans penis (χ(2)=23.709, P<0.01). (3) The well developed urethral mucous membrane had a lower complication rate(χ(2)=12.086, P<0.01). (4) When the angle of ventral curvature was larger than 30°, a higher complication rate occurred(χ(2)=10.233, P<0.01). CONCLUSION: Tubularized incised plate urethroplasty procedure for single-stage urethroplasty is the first choice for patients with big glans penis, normal development of urethral plate and slight curvature so as to achieve high curing rates and good shape of penis.

[Combination of compound Xuanju Capsule and sildenafil for erectile dysfunction that progressively fails to respond to sildenafil].

OBJECTIVE: To explore the clinical effects of Compound Xuanju Capsule (CXC) combined with sildenafil on erectile dysfunction (ED) that progressively fails to respond to sildenafil. METHODS: Totally, 36 ED patients who progressively failed to respond to sildenafil were randomly divided into a trial and a control group of equal number, the former treated with oral CXC at 3 g tid plus sildenafil at 50 mg an hour before sexual activity, while the latter with sildenafil alone at 100 mg an hour before sexual activity. After 2 months of treatment, we compared the patients' scores on IIEF-5 and their partners' scores on Treatment Satisfaction Scale (TSS) between the two groups. RESULTS: The total rate of erectile function improvement was 94.44% in the trial and 88.89% in the control group (P > 0.05). The IIEF-5 score was 20.888 9 +/- 3.833 1 in the former and 18. 777 8 +/- 4.008 2 in the latter after treatment, significantly higher than 13. 166 7 +/- 3.601 5 and 13. 055 6 +/- 2.775 4 before treatment (P < 0.05). The post-treatment IIEF-5 scores of the patients and the TSS scores of their partners were markedly higher in the trial than in the control group (P < 0.05). CONCLUSION: Compound Xuanju Capsule combined with sildenafil is effective for erectile dysfunction that progressively fails to respond to sildenafil.

[Application of tubularized incised plate in one-stage urethroplasty for hypospadia accompanied with anatomic kak-factors].

OBJECTIVE: To investigate the application of tubularized incised plate (TIP) in urethroplasty for hypospadia accompanied with anatomic kak-factors. METHODS: We retrospectively studied 191 cases of hypospadia treated by one-stage TIP urethroplasty. Taking the position of the urinary meatus, the development of the glans penis and urethral plate, and the degree of penile ventral curvature as anatomic kak-factors inducing postoperative complications and affecting the appearance, we conducted correlation analyses on the clinical effects of the procedure using SPSS 10.0 statistics. RESULTS: Postoperative complications were closely correlated with the position of the urinary meatus, the nearer its position to the coronary sulcus, the higher the incidence of complications (chi2 = 24.291, P < 0.01). And so were they with the development of the glans penis and urethral plate and the degree of penile ventral curvature. The incidence of postoperative complications was significantly higher in the hypospadia patients with small glans, maldeveloped urethral plate and severe penile ventral curvature than in those with straight penis and well-developed glans and urethral plate (chi2 = 25.419, P < 0.01). CONCLUSION: Tubularized incised plate urethroplasty for hyper-spadias should be chosen according to the position of the meatus, the development of urethral mucous membrane, the degree of ventral curvature and surgery experience in order to achieve a high cure rate and good cosmetic effect.