A Survival Model for Patients with Upper Tract Urothelial Carcinoma.

OBJECTIVES: We aimed to establish a survival model for patients with upper tract urothelial carcinoma (UTUC). METHODS: A total of 241 patients with UTUC treated from January 2010 to December 2018 were selected. Their general clinical data were collected, and urological indices were measured. They were followed up after discharge, and divided into a death group (n = 51) and a survival group (n = 190) to compare the clinical data. Multivariate logistic regression analysis was performed to analyze the independent risk factors for postoperative death, based on which a nomogram prediction model was established and then validated. RESULTS: The death group had significantly older age, larger tumor diameter, and higher tumor grade, pathological stage and proportion of no adjuvant chemotherapy than those of the control group (p < 0.01). The results of multivariate logistic analysis suggested that high tumor grade, tumor located in the ureter, large tumor diameter, high pathological stage, and lymph node metastasis were independent risk factors for postoperative death. A nomogram prediction model was established based on the prognostic independent risk factors. The area under the curve of receiver operating characteristic curve was 0.828 (95% confidence interval (CI): 0.801-0.845), so the model had good discrimination. The calibration curve showed that the model had high consistency. CONCLUSIONS: The established nomogram model can be used to predict the mortality risk of patients with UTUC and postoperative survival, and to develop individualized treatment plans for improving the prognosis and survival.

A Survival Model for Patients with Upper Tract Urothelial Carcinoma

Objectives: We aimed to establish a survival model for patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 241 patients with UTUC treated from January 2010 to December 2018 were selected. Their general clinical data were collected, and urological indices were measured. They were followed up after discharge, and divided into a death group (n = 51) and a survival group (n = 190) to compare the clinical data. Multivariate logistic regression analysis was performed to analyze the independent risk factors for postoperative death, based on which a nomogram prediction model was established and then validated. Results: The death group had significantly older age, larger tumor diameter, and higher tumor grade, pathological stage and proportion of no adjuvant chemotherapy than those of the control group (p < 0.01). The results of multivariate logistic analysis suggested that high tumor grade, tumor located in the ureter, large tumor diameter, high pathological stage, and lymph node metastasis were independent risk factors for postoperative death. A nomogram prediction model was established based on the prognostic independent risk factors. The area under the curve of receiver operating characteristic curve was 0.828 (95% confidence interval (CI): 0.801–0.845), so the model had good discrimination. The calibration curve showed that the model had high consistency. Conclusions: The established nomogram model can be used to predict the mortality risk of patients with UTUC and postoperative survival, and to develop individualized treatment plans for improving the prognosis and survival (AU)

Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features.

OBJECTIVES: Preeclampsia with severe features (PECsf) is a common disease in pregnant women. let-7a and IFN-gamma (interferon-gamma) are involved in diagnosis and prognosis of preeclampsia. This study explored effects of let-7a and IFN-gamma on PECsf patients. METHODS: The placental tissue of 21 PECsf, 19 preeclampsia without severe features (PEC), and 20 normal pregnant women were collected, and clinical data were recorded. let-7a and IFN-gamma expressions in placental tissue were detected. The correlation between let-7a/IFN-gamma expression and clinical indexes was analyzed. According to let-7a and IFN-gamma expressions, PECsf patients were assigned into Hlet-7a group (let-7a high expression group), Llet-7a group (let-7a low expression group), HIFN-gamma group (IFN-gamma high expression group) and LIFN-gamma group (IFN-gamma low expression group). The incidence of adverse prognosis was compared. RESULTS: let-7a and IFN-gamma were highly expressed in placental tissue of preeclampsia patients, with significant differences between PEC and PECsf. The high expressions of let-7a and IFN-gamma were positively correlated with mean arterial pressure, lactate dehydrogenase, and 24 h urinary protein in placental tissues of PECsf patients. High let-7a and IFN-gamma expressions were correlated with adverse outcomes of PECsf. CONCLUSIONS: High let-7a and IFN-gamma expressions were correlated with clinical features, and could be used as biomarkers for treatment and poor prognosis of PECsf.

Effects of intrahepatic cholestasis of pregnancy on hepatic function, changes of inflammatory cytokines and fetal outcomes.

The effects of intrahepatic cholestasis of pregnancy (ICP) on hepatic function, changes of inflammatory cytokines and fetal outcomes were studied. In total, 663 pregnant women admitted to Daqing Longnan Hospital from July 2016 to December 2017 were selected. There were, 40 cases with ICP enrolled in the observation group, and 40 normal pregnant women were recruited in the normal group. They were also grouped according to hepatic function and inflammatory cytokines, with 40 cases in each group. Neonatal Apgar scores were recorded. The correlations of serum cholylglycine (CG) in pregnant women with umbilical artery systolic-to-diastolic (S/D) ratio in the third trimester of pregnancy, the alanine aminotransferase level, the high-sensitivity C-reactive protein (hs-CRP) level, neonatal Apgar score and gestational week were analyzed. The birth weight in the observation group was lighter than that in the normal group (P<0.05); the gestational week at birth was earlier than that in the normal group (P<0.05); Apgar score at birth was lower than that in the normal group (P<0.05), and the levels of inflammatory cytokines were higher than those in the control group (P<0.05). Apgar scores of newborns at birth and at 1 and 5 min after birth in the normal hepatic function and normal inflammatory cytokine groups were higher than those in the abnormal hepatic function group (P<0.05). The serum CG level in pregnant women was positively correlated with umbilical artery S/D ratio, the alanine aminotransferase level and the hs-CRP level in the third trimester of pregnancy, but negatively correlated with neonatal Apgar score and gestational week. Among patients with ICP, the higher the GG level in the body is, the higher the alanine aminotransferase, inflammatory cytokine and umbilical artery S/D ratio will be, which may cause lower neonatal Apgar score, neonatal asphyxia and premature delivery.

Curative effect of laparoscopic hysterectomy for uterine fibroids and its impact on ovarian blood supply.

This study evaluates the curative effects laparo-scopic hysterectomies performed to treat uterine fibroids and determined the impact of the procedures on ovarian blood supply. A total of 124 patients with uterine fibroids admitted and treated in our hospital from December 2014 to December 2015 participated in the study. Two groups of 62 patients each were formed according to different operating plans; one group of patients underwent abdominal (open) panhysterectomy and were set as the control group; with the other group of patients were treated with laparoscopic hysterectomy and were set as the observation group. Ovarian endocrine function tests and blood supply changes were measured in both groups before the operation and one month after it, and the clinical conditions of all the patients were followed up for 24 months after surgery. Our results showed the duration of operation, amount of bleeding and time to recovery after the procedure were significantly lower in the patients in the observation group (P<0.05). Also, compared with preoperative conditions, the levels of PRL, FSH, E2, LH and other ovarian function markers in both groups were significantly lower one month after the operation, but the levels of the patients in the observation group were still significantly higher than those of the patients in the control group (P<0.05). Likewise, the surgeries affected the ovarian blood supply in patients of both groups, as evidenced by the lower levels of PI, RI, Vmin, Vmax and other blood supply indexes observed by Doppler ultrasound a month after the operations. However, the impact of the surgery on the ovarian blood supply was less marked in the patients in the observation group as their levels remained higher than those of patients in the control group (P<0.05). The numbers of patients with completely healed abdominal muscular layers in the observation group were always significantly higher than those of patients in the control group, at every different time point examined (1, 4, 8 and 12 months after surgery) (P<0.01). At the end of the 24 months of the follow-up period, the recurrence rate of fibroids for patients in the observation group was 4.8%. In our hands, the laparoscopic hysterectomy procedure to treat uterine fibroids showed the usual advantages over the abdominal open hysterectomy, like small trauma, short surgical procedure and rapid postoperative recovery, but it also proved to cause a significantly smaller impact on ovarian blood supply and should be considered whenever uterus preservation is a priority.

Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients.

Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias.

Non-ingested Intraperitoneal Foreign Body Extraction by Transumbilical Endoscopic Surgery in a 2-year-Old Girl.

In this article, we present an unusual case of a girl who had a mass present in the right lower quadrant of the abdomen and imaging analysis showed that to be a sewing needle. Patient was admitted electively and taken to the operation theater for removal of a foreign body under general anesthesia. The needle was extracted with transumbilical endoscopic surgery (TUES) without any evidence of intra-abdominal organ injury and with a good long-term cosmetic outcome. This case highlights the subtleties of TUES in the management of intra-abdominal foreign bodies in children including rare causes such as non-ingested foreign bodies.

Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children.

PURPOSE: To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. METHODS: In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. RESULTS: The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. CONCLUSIONS: Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results.

Transumbilical endoscopic surgery for completely enclosing inguinal hernias in children.

BACKGROUND/PURPOSE: There has been great interest in natural orifice transluminal endoscopic surgery in recent years. We report another new approach for pediatric inguinal hernia repair: transumbilical endoscopic surgery (TUES). Compared with the natural orifice transluminal endoscopic surgery technique, TUES can obtain similar scarless results on the abdomen. METHODS: In our hospital, 2-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through 2 intraumbilical incisions, two 5-mm trocars were inserted into the abdomen under laparoscopic guidance. With the use of a needle-holding forceps, a round needle with 2-0 nonabsorbable suture material was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and intraperitoneal knot-tying was performed. RESULTS: A total of 76 inguinal repairs were performed in 64 children (age range, 6 months to 9 years; median, 3.8 years; 44 boys, 20 girls). All operations were completed successfully by TUES, with the exception of one case of intraoperative bleeding because the inferior epigastric vein was punctured. The mean operating time was 20 minutes (range, 15-30 minutes). No postoperative bleeding, hydrocele, or scrotal edema in this group of patients was found, and there were no known cases of postoperative testicular atrophy or hypotrophy nor hernia recurrence on the symptomatic side. CONCLUSIONS: Our preliminary experience shows satisfactory outcomes with TUES for completely enclosing inguinal hernias in children. This technique appears to be safe, effective, and reliable. The cosmetic result is excellent.

Inflammatory myofibroblastic tumor of the rectum in a 13-month-old girl: a case report.

Inflammatory myofibroblastic tumor is a rare benign neoplasm. It is common in children and has been reported in various locations throughout the body but rarely in the rectum. A 13-month-old girl presented with a short history of a painless anal mass and no hematochezia. The mass was completely excised, and histologic examination of the initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with predominance of plasma cells, typical of an inflammatory pseudotumor. The spindle cells were positive for smooth muscle actin and anaplastic lymphoma kinase staining. There is no evidence of recurrence or metastasis after a follow-up of 4.5 years.

Association analysis of the RET proto-oncogene with Hirschsprung disease in the Han Chinese population of southeastern China.

Hirschsprung disease (HSCR) is a complex congenital disorder characterized by intestinal obstructions caused by the absence of the intestinal ganglion cells of the nerve plexuses in variable lengths of the digestive tract. This study investigated a possible role of the RET proto-oncogene in sporadic HSCR patients in the Han Chinese population. Our results indicated that rs1800858, rs1800860, rs1800863, and rs2075912, located in exons 2, 7, 15, and intron 19 of RET, are strongly associated with the disease (P < 0.01), with rs1800860 and rs1800863 playing a protective role in the pathogenesis of HSCR in the Chinese population. We also showed that the haplotype consisting of four SNPs is significantly associated with HSCR. We did not find a significant difference in the CA-repeat in intron 5 of RET between cases and controls. Our study provided further evidence that the RET gene is involved in the susceptibility to HSCR in the Han Chinese population.

Association analysis of the PHOX2B gene with Hirschsprung disease in the Han Chinese population of Southeastern China.

BACKGROUND: Hirschsprung disease (HSCR, OMIM 142623) is a complex congenital disorder characterized by intestinal obstructions caused by the absence of the intestinal ganglion cells of the nerve plexuses in variable lengths of the digestive tract. The PHOX2B gene is involved in neurogenesis and disruption of Phox2b in mice results in a HSCR-like phenotype. The first association study of the PHOX2B gene with HSCR derived from Chinese population in Hong Kong; here, we address the question of whether PHOX2B acts as a predisposing factor in HSCR pathogenesis in Chinese population in mainland. METHODS: To investigate the contribution of PHOX2B to the HSCR phenotype, polymerase chain reaction amplification and direct sequencing were used to screen PHOX2B coding regions and intron/exon boundaries for mutations and polymorphisms in 102 patients with HSCR and 96 ethnically matched controls, in Han Chinese populations of Southeastern China. RESULTS: In this study, we genotyped 4 single nucleotide polymorphisms (SNPs) (including 1 novel SNP) located within the PHOX2B gene. Statistically significant differences were found for c.701 A > G and IVS2 + 100 A > G, and the log-additive model was accepted as the best inheritance model (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.11-2.87) for IVS2 + 100 A > G. We also showed that the haplotype-A G A N composed of 4 SNPs exhibited significant association with the disease (P = .03); this haplotype was more frequently observed in cases than in controls (OR, 2.31; 95% CI, 1.11-4.82). CONCLUSIONS: Our study provided further evidence that the PHOX2B gene is involved in the susceptibility to HSCR in the Han Chinese population. Our findings are in accordance with the involvement of PHOX2B in the signaling pathways governing the development of enteric neurons.

[Effects of tannic acid pretreatment on cardiovascular function during hemorrhagic shock in rats].

OBJECTIVE: To investigate the effects of tannic acid pretreatment on cardiovascular function during hemorrhagic shock in rats. METHODS: Sprague-Dawley (SD) rats were randomly divided into two groups of shock and tannic acid pretreatment+shock. (1) In vivo experiment: the model of hemorrhagic shock in rats was reproduced by bleeding to 40 mm Hg (1 mm Hg = 0.133 kPa) being maintained for 120 minutes. Tannic acid in the dosage of 5 mg/kg was injected intravenously 10 minutes before hemorrhagic shock in tannic acid pretreatment+shock group. The mean arterial pressure (MAP), myocardial contractility and vascular reactivity were measured before hemorrhagic shock and at 180 minutes after hemorrhagic shock. In another experiment, the rats subjected to hemorrhagic shock and blood reinfusion were injected with norepinephrine (NE) intravenously at 60,120 and 180 minutes, and the vascular reactivity was observed. (2) In vitro experiment: the heart was harvested after shock and fixed on a Langendorff system. The perfusion pressure was maintained at 100 mm Hg. The effects of tannic acid pretreatment on myocardial contractility was observed. RESULTS: (1)In vivo experiment showed that tannic acid pretreatment significantly increased MAP at 60 minutes and 150 minutes, and left ventricular systolic pressure (LVSP) at 60 minutes, and the heart rate was obviously slowed at 120 minutes, and left ventricular end diastolic pressure (LVEDP) was lowered (all P < 0.05). The vascular reactivity was significantly improved at 120 minutes in tannic acid pretreatment+shock group compared with shock group (P < 0.05). (2) In vitro experiment proved that tannic acid pretreatment significantly slowed heart rate at 90 minutes as well as increased +dp/dtmax at 10 minutes and 20 minutes and -dp/dtmax at 10 minutes (all P < 0.05). CONCLUSION: Pretreatment with tannic acid improves cardiovascular function following hemorrhagic shock to some extent in rats.

RET polymorphisms and the risk of Hirschsprung's disease in a Chinese population.

Hirschsprung's disease (HSCR) is a congenital disorder characterized by intestinal obstructions due to the absence of enteric ganglia along variable lengths of the intestinal tract. RET coding mutations have been found in approximately 50% of familial cases, but they only explain a minority of sporadic cases. Here, we report our investigation of a possible role of RET non-coding mutations in sporadic HSCR patients. The haplotypes of seven single nucleotide polymorphisms (SNPs), all located in a region 4 kb upstream of the gene through to 23 kb of intron 1, and one SNP in exon 2 were constructed in 125 Han Chinese patients with sporadic HSCR and in 148 Han Chinese controls. Our results indicated that eight SNPs were significantly associated with HSCR (P < 0.0001). The C allele of rs2505535 would appear to represent a protecting allele for the Chinese population. One single haplotype composed of these eight markers was present in 59.6% of patients, versus 18.1% of controls. Based on our results, we conclude that non-coding mutations in RET have important roles in the development of HSCR. The unknown functional disease variant(s), with a dosage-dependent effect in HSCR, is likely to be located in the 5'-region of the RET gene.

HSD is a better resuscitation fluid for hemorrhagic shock with pulmonary edema at high altitude.

To investigate the fluid tolerance of hemorrhagic shock with pulmonary edema (HSPE) at high altitude in unacclimated rats and the beneficial effect of 7.5% hypertonic saline/6% dextran (HSD). One hundred seventy-six Sprague-Dawley rats, transported to LaSa, Tibet, 3,760 m above the sea level, were anesthetized with sodium pentobarbital (30 mg/kg, i.p.) within 1 week. Hemorrhagic shock with pulmonary edema was induced by bloodletting (50 mmHg for 1 h) plus intravenous injection of oleic acid (50 microL/kg). Seventy-seven rats were equally divided into 11 groups (n = 7/group) including sham-operated control group; hemorrhagic shock control group; HSPE control group; HSPE plus 0.5-, 1.0-, 1.5-, 2.0-, or 3.0-fold volumes of lactated Ringer's solution (LR) groups; and HSPE plus 4, 6, and 8 mL/kg of HSD groups. Hemodynamic parameters including mean arterial blood pressure, left intraventricular systolic pressure, and the maximal change rate of intraventricular pressure rise or decline (+/-dp/dtmax) were observed at baseline and at 15, 30, 60, and 120 min after infusion; blood gases were measured at 30 and 120 min after infusion, and the water content of lung and brain was determined at 120 min after infusion. Additional 99 rats were used to observe the effect of these treatments on the survival time of HSPE rats; 0.5 volume of LR infusion slightly increased the mean arterial blood pressure, left intraventricular systolic pressure, and +/-dp/dtmax and prolonged the survival time of HSPE animals as compared with the HSPE group (P < 0.05 - 0.01); it did not increase the water content of lung and brain and had no marked influences on blood gases. One volume of LR infusion had somewhat improved the hemodynamic parameters for HSPE animals, but had no apparent effect on the survival time and the water content of lung and brain. Lactate Ringer's solution infusion, 1.5, 2, and 3 volumes, significantly deteriorated the hemodynamic parameters, increased the water content of lung, and decreased the survival time of HSPE animals. Hypertonic saline/6% dextran (4 - 8 mL/kg) significantly increased the hemodynamic parameters, improved the blood gases, decreased the water content of lung and brain, and prolonged the survival time of HSPE rats. Among the three dosages of HSD, 6 mL/kg of HSD had the best effect. The tolerance of fluid infusion for hemorrhagic shock with pulmonary edema at high altitude is significantly decreased. More than one volume of LR infusion would aggravate the pulmonary edema and exacerbate the resuscitation effect, but only one volume of LR cannot reach the effective volume resuscitation. Small volume of HSD could better resuscitate hemorrhagic shock with pulmonary edema at high altitude.

[Effect of poly-adenosine diphosphate ribosyl-polymerase on vascular hyporeactivity in rats with hemorrhagic shock].

OBJECTIVE: To study the effects of poly-adenosine diphosphate ribosyl-polymerase (PARP) on vascular hyporeactivity during hemorrhagic shock in rats. METHODS: Sprague-Dawley (SD) rats were randomly divided into three groups: shock, 3-aminobenzamide (3-AB) pretreatment+shock, and sham operation. Bleeding from the femoral artery to induce hemorrhagic shock model. The blood pressure changes following 3 microg/kg norepinephrine (NE) injection were observed in vivo. The response of vascular rings of superior mesenteric artery (SMA) to NE was determined ex vivo. The nitrogen monoxide (NO) contents of plasma and tissue homogenate of SMA were measured using the assay kit based on the nitrate reductase reaction. RESULTS: The maximum increase of mean arterial pressure in response to NE immediately following shock in the shock group was significantly lower than in the sham operation group (P<0.01) and the value at 1 hour after blood reinfusion in the shock group was obviously lower than in the 3-AB pretreatment+shock group (P<0.05) and in the sham operation group (P<0.01). The maximum concentration force in the sham operation group [(0.367 1+/-0.221 3)g/mm] was significantly increased than in the 3-AB pretreatment+shock group [(0.286 4+/-0.153 2) g/mm, P<0.05] and in the shock group [(0.185 6+/-0.111 3)g/mm, P<0.01]. The cumulative dose-response curves of SMA to NE shifted to the left, and the contraction force was markedly increased as NE concentration reaching 10(-6), 10(2+) and 10(-5) mol/L in the 3-AB pretreatment+shock group compared to the shock group (all P<0.05). There were no significant difference on plasma NO content among the three groups. However, the NO contents of plasma and tissue homogenate of SMA in the 3-AB pretreatment+ shock group were slightly lower than in the shock group (P>0.05). CONCLUSION: PARP is involved in the vascular hyporeactivity in hemorrhagic-shocked rats.

[Experimental study on changes in myocardial systolic function and arterial blood gases after impact injury to liver in rabbits].

OBJECTIVE: To explore the effects of impact injury of liver on myocardial systolic function and arterial blood gases in rabbits. METHODS: A model of hepatic impact injury was reproduced in rabbits by hitting the xiphoid area with two falling steel balls. Myocardial systolic function and arterial blood gases were measured respectively before injury, immediately and 0.5, 1, 2 hours after injury, and before the death. RESULTS: After injury, heart rate (HR), left ventricular systolic pressure (LVSP), the maximum change rate of left ventricular pressure rise and fall (+/-dp/dt max) descended significantly, while left ventricular end-diastolic pressure (LVEDP) showed no statistically significant change. At the same time, blood pH and HCO(3)(-) fell gradually, and negative base excess (BEecf) showed a significant increase, indicating metabolic acidosis gradually developed. There was no obvious significant difference in partial pressure of carbon dioxide in artery (PaCO(2)) between the values before and after injury. Partial pressure of oxygen in artery (PaO(2)) decreased gradually, but no significant differences were found between the values of 0.5 hour and 1 hour after injury and that before injury. CONCLUSION: After hepatic impact injury, myocardial systolic function deteriorates, metabolic acidosis appears.

[Activity of nuclear factor kappa B in rat pulmonary tissue after entrance of amniotic fluid into blood and inhibition with dexamethasone].

OBJECTIVE: To investigate the relationship between nuclear factor kappa B (NF-kappaB) and pulmonary injury in amniotic fluid embolism model of rat. METHODS: Seventy female Wistar rats were divided into five groups randomly: control group (6), amniotic fluid group (16), amniotic fluid + dexamethasone group (14), meconium group (20) and meconium + dexamethasone group (14). Different amniotic fluid was injected into jugular vein (dexamethasone was injected at 0.1 mg/100 g after entrance of amniotic fluid into blood) and blood pressure was examined. Pulmonary tissue was taken at 60 minutes. NF-kappaB activity was measured by Western-blot and percentage of NF-kappaB p65 positive cells in pulmonary tissue was determined by immunohistochemistry (HE). RESULTS: Dropsy, bleeding and neutrophil (PMN), macrophage, leukomonocyte infiltration were seen in four experimental groups. But none was found in control group. NF-kappaB activity in meconium group was 438,698 +/- 13,092, higher than those in amniotic fluid group, 377,982+/- 7,445, and in control group, 267,691 +/- 12 382 (F = 11.3, P < 0.01). With dexamethasone treatment, NF-kappaB activity was decreased, which was 308,826 +/- 13,771 in amniotic group and 339,516 +/- 17,358 in meconium group, respectively (t = 20.4 and t = 13.84, P < 0.01). Percentage of NF-kappaB p65 positive cells was higher in meconium group, 49.1 +/- 7.0, than in amniotic fluid group, 33.3 +/- 2.7, and control group, 13.3 +/- 2.1 (F = 1.17, P < 0.01). With dexamethasone treatment, the percentage decreased significantly to 22.9 +/- 3.0 and 21.4 +/- 3.6, respectively (t = 6.75 and t = 10.1, P < 0.05). CONCLUSIONS: NF-kappaB activity and percentage of NF-kappaB p65 positive cells are increased significantly, which is associated with pulmonary injury after entrance of amniotic fluid into blood and dexamethasone could inhibit NF-kappaB translocation to the nucleus to degrade NF-kappaB activity and alleviate pulmonary injury. NF-kappaB may be relevant to the occurrence and development of multiple organ dysfunction syndrome.

[Changes in systemic and local vascular reactivity in hemorrhagic shock and the therapeutic effect of delta opioid receptor antagonist ICI174,864].

OBJECTIVE: To investigate the changes in systemic and local vascular reactivity following hemorrhagic shock of different severity and the therapeutic effect of alpha opioid receptor antagonist ICI174,864. METHODS: Fifty-six Wistar rats were used in two experiments. In experiment I, 32 rats were equally divided into sham operation group, 1 hour, 2 hours and 3 hours hypotension groups. In the latter groups, rats were bled to a mean arterial blood pressure (MAP) of 40 mm Hg (1 mm Hg=0.133 kPa) and maintained at this level for 1, 2, 3 hours, respectively. The pressor response of blood pressure and the contractile response of superior mesenteric artery (SMA) to norepinephrine(NE, 3 ug/kg) were observed after shed blood was reinfused. In experiment II, 24 rats were divided into shock control, ICI174,864 0.5 mg/kg and 1.0 mg/kg groups. The response of blood pressure and SMA contractility to NE (3 microg/kg) were observed at 1, 2, and 4 hours after ICI174,864 administration. RESULTS: Following hemorrhagic shock, the systemic and local (SMA) vascular responsiveness was significantly decreased significantly and it was time dependent. Shed blood reinfusion alone did not restore the decreased vascular reactivity. ICI174,864 improved the decreased vascular reactivity in dose-dependent manner. CONCLUSION: Hemorrhagic shock can induce systemic and local vascular hyporeactivity. The decreased vascular reactivity is closely associated with the severity and duration of shock. Loss of systemic vascular reactivity parallels to that of the regional vessel. delta opioid receptor antagonist ICI174,864 has some beneficial effect in improving vascular hyporeactivity.

[Activity and role of tryptase after entrance of amniotic fluid into blood in rats].

OBJECTIVE: To investigate the activity and role of tryptase after entrance of amniotic fluid into blood in rats. METHODS: Thirty female Wistar rats (20 day pregnancy) were divided into the control group (10, injected with normal saline), amniotic group (10, injected with amniotic fluid), meconium group (10, injected with 1% meconium). After injection, pulmonary tissue was taken out. Tryptase activity was measured by special substrate. The histology of pulmonary tissue was determined by immunohistochemistry (HE). RESULTS: (1) Dropsy, hemorrhage, and infiltration of neutrophil (PMN), macrophage, leukomonocyte were observed in two experimental groups, but no such changes were found in control group. (2) After injection, tryptase activity in meconium group 176.4 +/- 8.6 and amniotic fluid group 165.4 +/- 7.4 was significantly higher than preexperimental groups 146.8 +/- 8.9 and 147.8 +/- 9.5, respectively (t = 7.58 and t = 4.64, P < 0.01); tryptase activity in control group was 145.3 +/- 10.6 before injection and 146.9 +/- 9.4 after injection, respectively, there was no difference (t = 0.37, P > 0.05). After injection, tryptase activity in meconium and amniotic fluid groups was significantly increased than that in control group (F = 30.66, P < 0.05). CONCLUSION: The activity of tryptase was significantly increased after entrance of amniotic fluid into blood in rats. Degranulation of mast cells to release tryptase may be the important cause of the pathophysiologic change after entrance of amniotic fluid into blood. These results suggest a role for mast cell activation in the mechanism of amniotic fluid embolism. This method is sensitive and effective for diagnosis of amniotic fluid embolism in clinic.