ABSTRACT
Acute kidney injury associated with renal hypoperfusion is a frequent and severe complication during sepsis. Fluid resuscitation is the main therapy. However, heart failure is usually lethal for those patients receiving large volumes of fluids. We compared the effects of small-volume resuscitation using four different treatment regimens, involving saline, hypertonic saline (HTS), hydroxyethyl starch (HES), or hypertonic saline hydroxyethyl starch (HSH), on the kidneys of rats treated with lipopolysaccharide (LPS) to induce endotoxemia. LPS injection caused reduced and progressively deteriorated systemic (arterial blood pressure) and renal hemodynamics (renal blood flow and renal vascular resistance index) over time. This deterioration was accompanied by marked renal functional and pathological injury, as well as an oxidative and inflammatory response, manifesting as increased levels of tumor necrosis factor-α, nitric oxide, and malondialdehyde and decreased activity of superoxide dismutase. Small-volume perfusion with saline failed to improve renal and systemic circulation. However, small-volume perfusion with HES and HSH greatly improved the above parameters, while HTS only transiently improved systemic and renal hemodynamics with obvious renal injury. Therefore, single small-volume resuscitation with HES and HSH could be valid therapeutic approaches to ameliorate kidney injury induced by endotoxemia, while HTS transiently delays injury and saline shows no protective effects.
Subject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Endotoxemia/complications , Fluid Therapy/methods , Hydroxyethyl Starch Derivatives/therapeutic use , Animals , Endotoxemia/chemically induced , Lipopolysaccharides/toxicity , Male , Rats , Rats, Sprague-Dawley , Saline Solution, Hypertonic/therapeutic useABSTRACT
The aim of this paper is to develop a method for ranking trapezoidal intuitionistic fuzzy numbers (TrIFNs) in the process of decision making in the intuitionistic fuzzy environment. Firstly, the concept of TrIFNs is introduced. Arithmetic operations and cut sets over TrIFNs are investigated. Then, the values and ambiguities of the membership degree and the nonmembership degree for TrIFNs are defined as well as the value-index and ambiguity-index. Finally, a value and ambiguity-based ranking method is developed and applied to solve multiattribute decision making problems in which the ratings of alternatives on attributes are expressed using TrIFNs. A numerical example is examined to demonstrate the implementation process and applicability of the method proposed in this paper. Furthermore, comparison analysis of the proposed method is conducted to show its advantages over other similar methods.
Subject(s)
Algorithms , Models, TheoreticalABSTRACT
In view of the insufficient source profiles for emissions from nonmetal mineral products manufacturing processes in China, a dilution sampling system was used to collect PM10 and PM2.5 samples from glassmaking, ceramics, and firebrick manufacturing sources between February and June of 2017. The characteristics of 50 chemical components in the samples were studied to identify source profiles. The results showed that the dominant composition of particulate matter in glassmaking plant profiles was Na, with percentages ranging from 9.2% to 18.5%. Ceramics profiles were enriched in Al, Si, Ca, and Fe, with percentages ranging from 1.7% to 8.7%. Refractory brick and shale manufacturing process profiles were characterized by high abundances of SO42- (36.9%-48.1%) and NH4+ (7.7%-17.0%). Chemical components in the source profiles varied with the different fuel types and desulfurization, denitrification, and dedusting methods. The coefficients of divergence (CD) between PM2.5 and PM10 from the same process were similar except for the results from the shale manufacturing process (CD values>0.3), thus indicating that the elements profiles of PM2.5 might be similar to those in PM10. Profiles of the same particle size from different processes were significantly different from one another, with CD values ranging from 0.42 to 0.76. The CD values for float glass and medicinal glass, and the CD values for the two ceramic enterprises were relatively small. The distributions of weighted differences (R/U ratios) were used to compare the differences of components between the source profiles, and results showed that the identified components for glass manufacturing, ceramic manufacturing, fireproof bricks, and page rock bricks were Na and As, Al and Ti, NO3- and NH4+, and SO42- and NH4+, respectively.
ABSTRACT
OBJECTIVE: To explore clinical characteristics and treatment of posterior Pilon fracture. METHODS: From January 2011 to January 2013,18 patients with posterior Pilon fracures were treated. Among them, 13 were male and 5 were female, aged from 22 to 63 years old, with an average age of 46. All the patients were closed fractures. Open reduction and internal fixation were performed after swelling subsided, lateral malleolous and posterior Pilon fracture were exposured through lateral approach on healthy side, plates were used to fixed,screws or small plates were used to fix the posterior prominence of medial malleolus after changed to supine position. AOFAS scoring were applied to evaulate clinical effects. RESULTS: All patients were followed up with an average of 22(ranged, 12 to 48)months. All patients obtained satisfactory reset except one patient. All factures were recovered well with an average healing of 11 weeks. According to AOFAS score at the final following up, 7 cases were excellent,2 cases were moderate, and the total score was 86.8±9.2. CONCLUSION: Posterior Pilon fracture is not rare in clinical, its mechanism of injury, traumatic anatomy, surgical procedure and prognosis are different from that of classical ankle fracture and Pilon fracture.
Subject(s)
Ankle Injuries/surgery , Tibial Fractures/surgery , Adult , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
STUDY OBJECTIVE: To investigate the onset and analgesic effect of adding dexmedetomidine to levobupivacaine for caudal block in young children. DESIGN: Randomized, prospective, double-blind study. SETTING: Women and Children Medical Center and university hospital. PATIENTS: Two hundred twelve children, American Society of Anesthesiologists physical status I or II, aged between 1 and 3 years and weighing between 8 and 18 kg, who were scheduled for elective inguinal hernia repair or hydrocele. INTERVENTIONS: Children were randomly allocated, using a computer-generated sequence of numbers, into 1 of 3 groups: caudal 0.25% levobupivacaine (Group L(0.25)), caudal 0.20% levobupivacaine (Group L(0.20)), or caudal 0.20% levobupivacaine plus 2 µg/kg dexmedetomidine (Group LD). MEASUREMENTS AND MAIN RESULTS: The primary end point of the study was the onset time of caudal levobupivacaine in children. The secondary end points of the study were the duration of analgesia and the degree of motor block in children. The 50% and 95% effective onset time (95% confidence interval) values of levobupivacaine were 8.19 minutes (7.30-9.08) and 11.17 minutes (9.44-12.91) in Group L(0.25), 10.16 minutes (8.90-11.41) and 15.85 minutes (13.14-18.57) in Group L(0.20), and 9.91 minutes (8.55-11.28) and 16.39 minutes (13.32-19.46) in Group LD, respectively. The mean durations of analgesia in these children were 7.23, 5.84, and 19.6 hours in Groups L(0.25), L(0.20), and LD, respectively. There were no significant differences in postoperative residual motor block among the 3 groups. CONCLUSIONS: Dexmedetomidine added to levobupivacaine does not have a significant effect on the onset time; however, it prolongs the duration of analgesia during caudal block in children.
Subject(s)
Anesthetics, Local/administration & dosage , Bupivacaine/analogs & derivatives , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Anesthesia, Caudal/methods , Bupivacaine/administration & dosage , Child, Preschool , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Infant , Levobupivacaine , Male , Nerve Block/methods , Prospective Studies , Time FactorsABSTRACT
Sepsis induces hepatic injury but whether alpha-2 adrenoceptor (α2-AR) modulates the severity of sepsis-induced liver damage remains unclear. The present study used lipopolysaccharide (LPS) to induce hepatic injury and applied α2-AR agonist dexmedetomidine (DEX) and/or antagonist yohimbine to investigate the contribution of α2-AR in LPS-induced liver injury. Our results showed that LPS resulted in histological and functional abnormality of liver tissue (ALT and AST transaminases, lactate), higher mortality, an increase in proinflammatory cytokines (IL-1ß, IL-6 & TNF-α), as well as a change in oxidative stress (MDA, SOD). Activation of α2-AR by dexmedetomidine (DEX) attenuated LPS-induced deleterious effects on the liver and block of α2-AR by yohimbine aggravated LPS-induced liver damage. Our data suggest that α2-AR plays an important role in sepsis-induced liver damage and activation of α2-AR with DEX could be a novel therapeutic avenue to protect the liver against sepsis-induced injury.
Subject(s)
Adrenergic alpha-2 Receptor Agonists/pharmacology , Chemical and Drug Induced Liver Injury/prevention & control , Dexmedetomidine/pharmacology , Lipopolysaccharides , Liver/drug effects , Receptors, Adrenergic, beta-2/drug effects , Adrenergic alpha-2 Receptor Antagonists/pharmacology , Alanine Transaminase/blood , Animals , Aspartate Aminotransferases/blood , Biomarkers/blood , Chemical and Drug Induced Liver Injury/blood , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/pathology , Cytoprotection , Disease Models, Animal , Interleukin-1beta/metabolism , Interleukin-6/metabolism , Lactic Acid/blood , Liver/metabolism , Liver/pathology , Male , Malondialdehyde/metabolism , Oxidative Stress/drug effects , Rats, Sprague-Dawley , Receptors, Adrenergic, beta-2/metabolism , Sepsis/chemically induced , Superoxide Dismutase/metabolism , Time Factors , Tumor Necrosis Factor-alpha/metabolism , Yohimbine/pharmacologyABSTRACT
OBJECTIVE: To observe the clinical characteristics of triceps brachii tendon rupture at olecranon ending. METHODS: From June 2005 to November 2011,19 patients with triceps brachii tendon rupture at olecranon ending were treated with surgical technique. Among the 19 patients, 7 patients were male, with an average age of 24.1 years old (ranged, 15 to 41 years old); 12 patients were female, with an average age of 51.4 years old (ranged, 16 to 73 years old). Eight patients had injuries in the left elbows, and 11 patients had injuries in right elbows. Seventeen patients had injuries induced by walking fall and 2 patients had injuries induced by falling down. Thirteen patients were simple triceps brachii tendon rupture at olecranon ending, 6 patients were associated with other elbow injuries. Five patients were associated with radial fracture; 1 patient with capitellum fracture; 1 patient with coronoid process fracture; 1 patient with epitrochlear. All the lateral radiographs of the injuried elbow demenstrated the flecks of avulsed osseous material from the olecranon (flake sign). The associated injuries had the homologus presence. All the patients were treated with surgical techniques:15 patients were treated with figure-of-eight tension-band wire; figure-of-eight tension band wire and Kirschner wire in 1 patient; wire cerclage in 1 patient; nonabsorbable suture in 2 patients. The associated injuries were treated simultaneously. Plaster was applied after operation in 2 patients with heavier elbow associated injuries, other patients without any external fixation. The Mayo elbow score were observed to determinate the function of the elbow. RESULTS: All the patients were followed up, 1 patient died of other disease at one year after operation, the other 18 patients were followed up with an average of 47.9 months (ranged from 14 to 91 months). According to the Mayo elbow score, 16 patients got an excellent result and 2 good. CONCLUSION: Traumatic rupture of triceps brachii tendon at olecranon ending is not a rare injury, which is common in female older than fifty and in male younger then thirty. Surgical results are generally excellent. But dysfunction frequently remains in patients with associated elbow injuries.