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OBJECTIVE To establish the method for determination of bile acid active constituents （cholic acid， hyodeoxycholic acid and sodium taurocholate） in Babao jingfeng powder， and to compare the differences of 3 constituents in Babao jingfeng powder from different manufacturers. METHODS UPLC-MS method was adopted to determine the contents of cholic acid， hyodeoxycholic acid and sodium taurocholate in 9 batches of Babao jingfeng powder from 3 manufacturers. The separation was performed on a Phenomenex Luna® C18 column with mobile phase consisted of acetonitrile-water （gradient elution） at a flow rate of 0.5 mL/min. The column temperature was 40 ℃ and the sample size was 2 μL. MS system was operated in a negative ion single quadrupole mode， and the m/z of cholic acid， hyodeoxycholic acid and sodium taurocholate were 407.2， 392.2 and 514.2， respectively. With the contents of three components as the index， cluster analysis and principle component analysis were performed on 9 batches of samples. RESULTS The linear ranges of cholic acid， hyodeoxycholic acid and sodium taurocholate were 5.48- 548.40， 5.38-538.40， 4.74-474.05 ng/mL， respectively （r≥ 0.999 3）. RSDs of precision， repeatability and stability tests（24 h） were all lower than or equal to 3.7% （n＝6）， and the average recoveries were 103.3%， 103.3% and 101.6% with RSDs of 3.3%， 3.4%， 4.2% （n＝6）， respectively. The contentsof cholic acid ranged 0.702-1.711 mg/g， those of deoxycholic acid ranged 0.599-2.049 mg/g， and those of sodium taurocholate ranged 0.664-1.752 mg/g in 9 batches of samples. The average content of 3 components in samples from manufacturer A was high， and the difference between batches was the smallest； the average content of 3 components from manufacturer C was the lowest， and the difference between batches was large. Cluster analysis could basically distinguish samples from different manufacturers； cluster analysis was conducted by using the comprehensive score of principal components as an indicator， the results of which were basically consistent with those of cluster analysis for content. CONCLUSIONS The method is established successfully for the content determination of the 3 bile acid active constituents of artificial bezoar in Babao jingfeng powder. The contents of 3 components in Babao jingfeng powder from 3 manufacturers are significantly different.
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OBJECTIVE To establish the met hod for the purific ation of test sample of Banxialu granules ，and to determine the contents of 4 ephedrine components such as ephedrine ，pseudoephedrine，norpseudoephedrine and methylephedrine. METHODS Three batches of Banxialu granules were extracted with methanol（containing 1％formic acid ）and pretreated with QuEChERS method of N-propyl ethylenediamine adsorbent （PSA）and octadecyl bonded silica gel adsorbent （C18）. Ultra high performance liquid chromatography tandem triple quadrupole mass spectrometry （UHPLC-MS/MS）was adopted. The separation was performed on an Agilent XDB-C 18 column with 5 mmol/L ammonium acetate solution （containing 0.1％ formic acid ）-acetonitrile as mobile phase（gradient elution ）at the flow rate of 0.40 mL/min. The column temperature was set at 30 ℃，and sample size was 2 μL. The electrospray ionization source was adopted ，and positive ion scanning was performed in multiple reaction monitoring mode. The ion pairs used for quantitative analysis were m/z 166.2→148.1（ephedrine，pseudoephedrine），m/z 152.2→134.1（norpseudoephedrine）， m/z 180.2→162.2（methylephedrine）. RESULTS The solution obtained by QuEChERS purification method was clear and nearly colorless. The linear ranges of ephedrine ， pseudoephedrine， norpseudoephedrine and methylephedrine were 1.38-206.82， 1.41-212.13，1.29-19.34，1.99-59.83 ng/mL（r＞0.99）. The limits of detection were 0.41，0.42，0.39 and 0.60 ng/mL. The limits of quantitation were 1.38 ，1.41 ，1.29 and 1.99 ng/mL，respectively. RSDs of precision ，stability（48 h）and repeatability tests were all lower than 2％. The average recoveries were 95.75％-100.87％（RSD＜2％，n＝9）. The contents of above 4 ephedrine components were 20.62-26.02，20.96-24.90，2.26-2.63，5.36-6.32 μg/g， respectively. CONCLUSIONS Established method is simple ，rapid，sensitive and suitable for simultaneous determination of 4 ephedrine components in Banxialu granules.
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OBJECTIVE：To establish a method for the determination of plasma protein binding rate of rosmarinic acid ，caffeic acid and chlorogenic acid from Glechoma longituba . METHODS ：UHPLC method combined with ultrafiltration method was adopted to determine the plasma protein binding rate of rosmarinic acid ，caffeic acid and chlorogenic acid from G. longituba in the plasma of New Zealand rabbits. The determination was performed on a Phenomenex Luna ® C18 column with mobile phase consisted of acetonitrile （A）-0.1％ formic acid solution （B）（gradient elution ）at the flow rate of 0.5 mL/min. The column temperature was set at 45 ℃，and the detection wavelength was 327 nm. The sample size was 3 μL. RESULTS：At low ，medium and high concentrations，the plasma binding rates of rosmarinic acid were （97.78 ± 1.67）％ ，（94.32 ± 1.42）％ ，（95.12 ± 1.51）％ ， respectively（n＝3）；those of caffeic acid were （90.12±2.33）％，（89.53±1.98）％，（90.23±1.56）％，respectively（n＝3）；those of chlorogenic acid were （63.23 ± 2.12）％ ，（67.87 ± 1.06）％ ，（62.34 ± 1.34）％ ，respectively （n＝3）. CONCLUSIONS ： Established method is easy to operate and shorter time for analysis. It can be used to determine the plasma protein binding rate of rosmarinic acid ，caffeic acid and chlorogenic acid in G. longituba .
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Objective@#To evaluate the clinical efficacy of robot-assisted laparoscopic ureteral reimplantation (RAUR) for primary obstructive megaureter (POM) in children.@*Methods@#Twenty-one patients who underwent RAUR for POM in Bayi Children’s Hospital between 2017 April and 2018 April were retrospectively analyzed. The study population consisted of 15 boys and 6 girls aged between 2 months and 11 years. Ten patients had left POMs, 9 had right POMs and two had bilateral POMs. All patients were preoperatively diagnosed with a POM based on urinary system ultrasonography, magnetic resonance urography, and diuretic renal dynamic imaging. Our main technique key steps include: Under general anesthesia, the patients were placed in a Trendelenburg position approximately 40 degrees from the horizon. An 8.5-mm camera port was placed at the level of the umbilicus. Followed by two 5-mm robotic Trocars placed under direct vision 6 cm to the camera port separately, a 5-mm assistant port was placed on the right upper abdominal quadrants which was located 3 cm from the camera and robotic port. The ureter was identified at the pelvic brim. The peritoneum covering the ureter was incised and the ureter was mobilized to the level of the vesico-ureteric junction. The bladder was filled with 60 ml saline and a 5 cm length and 1.5 cm wide submucosal detrusor tunnel was created. The ureter was transected at the bladder mucosa and the narrowed ureteral segment was discarded. The ureteroneocystostomy was performed using 6-0 absorbable suture. Dissecting the perivesical fascia appropriately and using down-top suturing approach, use of an apical stay stitch, and incorporation of the ureteral adventitia during detrusorraphy. Postoperative complications were analysed using the Clavien-Dindo classification. Success was defined as symptomatic relief, decreased hydronephrosis on ultrasound and no evidence of vesicoureteral reflux on voiding cystourethrography.@*Results@#All surgeries were successfully completed without conversion and no intra-operative complication was encountered. The mean operative time was 117.6±18.1(89-165)min, the mean estimated blood loss was 11.9±4.3(5-25)ml, the abdominal drainage tubes were removed after a mean of 4.9±1.1(3-8)days, and the mean postoperative hospital stay was 6.3±1.3(4-10) days. Postoperative complications (Clavien Ⅰ-Ⅱ) occurred in 9.5% (two patients had recurrent urinary tract infections postoperatively) children, no grade Ⅲ-Ⅳ complication was observed. The pre-operative symptoms in all patients disappeared. One patient had grade Ⅱ VUR on VCUG, who were followed conservatively. Ultrasound at postoperative follow-up showed that the hydronephrosis was disappeared in 20 ureters and significantly decreased in 3 ureters. The success rate was 95.7% at a mean follow-up of 16.3±4.0(10-23)months.@*Conclusion@#RAUR is a safe and feasible option for the treatment of POM in children with higher success rate and lower complication rate.
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Objective To evaluate the clinical efficacy of robot-assisted laparoscopic ureteral reimplantation (RAUR) for primary obstructive megaureter (POM) in children.Methods Twenty-one patients who underwent RAUR for POM in Bayi Children's Hospital between 2017 April and 2018 April were retrospectively analyzed.The study population consisted of 15 boys and 6 girls aged between 2 months and 11 years.Ten patients had left POMs,9 had right POMs and two had bilateral POMs.All patients were preoperatively diagnosed with a POM based on urinary system ultrasonography,magnetic resonance urography,and diuretic renal dynamic imaging.Our main technique key steps include:Under general anesthesia,the patients were placed in a Trendelenburg position approximately 40 degrees from the horizon.An 8.5-mm camera port was placed at the level of the umbilicus.Followed by two 5-mm robotic Trocars placed under direct vision 6 cm to the camera port separately,a 5-mm assistant port was placed on the right upper abdominal quadrants which was located 3 cm from the camera and robotic port.The ureter was identified at the pelvic brim.The peritoneum covering the ureter was incised and the ureter was mobilized to the level of the vesico-ureteric junction.The bladder was filled with 60 ml saline and a 5 cm length and 1.5 cm wide submucosal detrusor tunnel was created.The ureter was transected at the bladder mucosa and the narrowed ureteral segment was discarded.The ureteroneocystostomy was performed using 6-0 absorbable suture.Dissecting the perivesical fascia appropriately and using down-top suturing approach,use of an apical stay stitch,and incorporation of the ureteral adventitia during detrusorraphy.Postoperative complications were analysed using the Clavien-Dindo classification.Success was defined as symptomatic relief,decreased hydronephrosis on ultrasound and no evidence of vesicoureteral reflux on voiding cystourethrography.Results All surgeries were successfully completed without conversion and no intra-operative complication was encountered.The mean operative time was 117.6 ± 18.1 (89-165)min,the mean estimated blood loss was 11.9 ± 4.3 (5-25) ml,the abdominal drainage tubes were removed after a mean of 4.9 ± 1.1 (3-8) days,and the mean postoperative hospital stay was 6.3 ± 1.3(4-10) days.Postoperative complications (Clavien Ⅰ-Ⅱ) occurred in 9.5％ (two patients had recurrent urinary tract infections postoperatively) children,no grade Ⅲ-Ⅳ complication was observed.The pre-operative symptoms in all patients disappeared.One patient had grade Ⅱ VUR on VCUG,who were followed conservatively.Ultrasound at postoperative follow-up showed that the hydronephrosis was disappeared in 20 ureters and significantly decreased in 3 ureters.The success rate was 95.7％ at a mean follow-up of 16.3 ± 4.0 (10-23) months.Conclusion RAUR is a safe and feasible option for the treatment of POM in children with higher success rate and lower complication rate.
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Objective To investigate the predictive value of D-dimer for early neurological deteriora- tion (END) in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Department of Neurology, the Second People ' s Hospital of Shenzhen between January 2015 and December 2017 were enrolled retrospectively. END was defined as an increase ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score or an increase ≥1 in the motor function score within 7 days after admission compared with the baseline score. Demographics, baseline clinical data, and primary treatment options during hospitalization were compared between the END group and the non-END groups. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of D-dimer for END. Results A total of 625 patients were enrolled in the study, including 40 in the END group (including 3 deaths) and 585 in the non-END group. The mean hospital stay, international normalized ratio, D-dimer, uric acid, NIHSS score and modified Rankin Scale (mRS) score at admission, and the proportion of patients with complete anterior circulation infarction, large atherosclerotic stroke, and pulmonary infection were significantly higher than those in the non-END group (all P < 0. 05). There was no significant difference in the proportion of patients receiving thrombolysis, antiplatelet,anticoagulation, and statins between the two groups. ROC curve analysis showed that the area under the curve of D-dimer predicting END was 0. 810 (95％ confidence interval [CI] 0. 736-0. 884; P < 0. 001); the optimal cut-off value was 2. 35 mg/L, and the sensitivity and specificity were 54. 74％ and 96. 13％ respectively. Multivariate logistic regression analysis showed that large atherosclerotic stroke (odds ratio [OR] 1. 115, 95％ CI 1. 005-1. 390; P = 0. 003 ), D-dimer ≥2. 35 mg/L (OR 1. 055,95％ CI 1. 012-1. 150; P = 0. 001 ), NIHSS score at admission (OR 1. 191, 95％ CI 1. 006-1. 410; P <0. 001), mRS score > 1 at admission (OR 1. 755, 95％ CI 1. 139-3. 656; P = 0. 037 ), and pulmonary infection (OR 2. 598, 95％ CI 1. 132-3. 081; P = 0. 012) were the independent risk factors for END in patients with acute ischemic stroke. Conclusion D-dimer ≥2. 35 mg/L at admission has higher predictive value for END in patients with acute ischemic stroke.
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Objective To investigate the feasibility and safety of robotic-assisted laparoscopic pyeloplasty (RALP) in infant ureteropelvic junction obstruction.Methods Of 31 infants who underwent RALP between March 2017 and August 2017 were reviewed,including 25 boys and 6 girls.22 infants were found that the hydronephrosis was in the left kidney and 9 in the right kidney.The average age of the infants was (3.5 ± 0.7) months,ranged from 8 days to 6 months,including 7 infants less than 2 months.The average weight of the infants was (6.7 ± 1.2) kg,with a minimum weight of 3.3 kg.The diagnosis and outcomes of ureteropelvic junction obstruction (UPJO) were reviewed on clinical and imaging data.The ultrasound showed that the mean anteroposterior diameter of hydronephrotic kidney was (4.01 ±0.56)cm.The split renal function was (37.1 ± 3.2) ％ in infants who were more than 2 months.Patients with proximal defect were positioned in the lateral flank position with 50°-70° inclination and as close as possible to the edge of operating table.The trocars of robotic lens and No.1 robotic arm were placed on the middle of the umbilicus and the Pfannenstiel line respectively,and the trocar of No.2 robotic arm was placed on the supraumbilical symmetry point of the trocar No.1 robotic arm,and the auxiliary trocar was placed on the Pfannenstiel line outside the 3-4 cm of healthy side of the trocar of No.1 robotic arm.During operation,the ureteropelvic junction was dissected and tailored.Then the ureter was open longitudinally at the posterior lateral side and was anastomosed at the lowest part the renal pelvis.We assessed preoperative clinical data and outcomes,and analyzed the transition experience.Data are expressed as medians for continuous variables.Results All operations were successful with no serious intraoperative complication and traditional laparoscopic or open surgical conversion.The average operative time was 108 min,the average intraoperative blood loss was 9.5 ml.The average drain removal was 1.2 days,the average start oral of feeding was 3.2 hours days and the average postoperative hospital stay was 6.2 days.Postoperative pathological results showed smooth muscle hyperplasia,hypertrophy and fibrous tissue in the urothelium,accompanied by chronic inflammation of urothelial mucosa.Patients with Clavien Ⅰ and Ⅱ complications 22.6％ (7/31) postoperatively were managed conservatively.Among them,there were 1 cases of flank pain,1 cases of hematuria,2 cases of urinary leakage,and 3 cases of urinary tract infection.Patients' symptoms disappeared by conservative treatment.No patient suffered Clavien Ⅲ and Ⅳ complication postoperatively.The renal pelvis anteroposterior diameter was 1.58 cm at three months postoperatively,which was significantly smaller than that of peroperation (P ＜ 0.05).A diuretic T1/2 showed the improvement of split renal function without urinary obstruction in all patients at three months postoperatively.The postoperative split renal function was (39.2 ± 3.5) ％,which was slightly higher than that of preoperation (P ＞ 0.05).Conclusions Severe hydronephrosis in neonates can be acted as an indication for exploratory surgery when the surgeon's ability,anesthesia,monitoring and management conditions are available.Robotic-assisted laparoscopic pyeloplasty is a safe and feasible option for the treatment of UPJO in infant with less trauma,rapid recovery and good cosmetic result.We suggest that RALP is potentially a recommended feasible treatment option for infant with UPJO.
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Objective To summarize the experience of patient positing,port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operations.Methods From March 2017 to December 2017,140 robot-assisted laparoscopic upper urinary tract procedures were performed in our institution,including 110 cases of pyeloplasty,15 upper pole heminephroureterectomy,12 simple nephrectomy and 3 adrenalectomy.There were 103 males and 37 females with a range age from 1 month to 18 years.The assistant surgeon was adjacent to the instrument nurse,and patients were placed in a supine position with 60°-80° inclination and keep the legs low to the body.Room setup and patient positioning were similar to the traditional laparoscopic surgery.Semi-hidden incision technique was used in 140 patients:the camera port was placed umbilicus,two additional arm ports (one 5 mm and one 8 mm) were placed under direct vision,the 8 mm arm port was placed on the line of a Pfannenstiel incision and the 5 mm arm port was placed below the Xiphoid along the midline.Finally,a 3 or 5 mm assistant port was placed approximately 3 cm lateral to the inferior arm port,the line of a Pfannenstiel incision.Results The average time was (11.5 ± 3.2) min (10.5-16.5 min) from skin incision to robot cart docking completed.All surgeries were successfully completed without open conversion.One patient required an additional assist port for severe adhesion after the previously open surgery,there was no injury to other viscera.Average operative time was (146.9 ± 48.7)min (78-259 min) and average post-operative hospitalization time was (5.7 ± 1.4) d(4-10 d),respectively.There was no visual scar on abdominal 6 weeks postoperatively,and all parents made comments about their satisfaction with the cosmetic appearance.All operations got complete success at a mean follow up of 6 (1-9) months.Conclusions A good room setup,patient positioning and the semi-hidden incision technique port placements are maintaining the safety of the patient,avoiding compression injuries,allowing maximum mobility of the robotic arms,and facilitating a smooth and efficient surgery,and improving post-operative recovery.
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OBJECTIVE:To optimize the extraction technology of total polyphenol and total flavonoid in Gardenia jasminoi-des. METHODS:Plackett-burman(PB)design was used to select the ethanol volume fraction,liquid-solid ratio,particle size,ex-traction time and extraction temperature to determine the key factor affecting the extraction of total polyphenol and total flavonoids in G. jasminoides. Then central composite design (CCD) was combined with response surface method to optimize the extraction technology,and verification test was conducted. RESULTS:The optimal extraction conditions of total polyphenol were 40% etha-nol,particle size of 0.20 mm,extraction temperature of 60 ℃,liquid-solid ratio of 20,and extraction time of 20 min;the optimal extraction conditions of total flavonoids were 40% ethanol,particle size of 0.20 mm,extraction temperature of 30 ℃,liquid-solid ratio of 20,and extraction time of 20 min. In verification test,the contents of total polyphenol and total flavonoids in G. jasminoi-des were 1.70%(RSD=1.43%,n=3),3.23%(RSD=3.72%,n=3),with relative error of 1.80%,8.75% with predicted val-ues,respectively. CONCLUSIONS:The response surface method based on PB and CCD is simple,reasonable and feasible to opti-mize the extraction technology of total polyphenol and total flavonoids in G. jasminoides. The method can provide reference for its industrial extraction.
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OBJECTIVE:To optimize the extraction technology of total polyphenol and total flavonoid in Gardenia jasminoi-des. METHODS:Plackett-burman(PB)design was used to select the ethanol volume fraction,liquid-solid ratio,particle size,ex-traction time and extraction temperature to determine the key factor affecting the extraction of total polyphenol and total flavonoids in G. jasminoides. Then central composite design (CCD) was combined with response surface method to optimize the extraction technology,and verification test was conducted. RESULTS:The optimal extraction conditions of total polyphenol were 40% etha-nol,particle size of 0.20 mm,extraction temperature of 60 ℃,liquid-solid ratio of 20,and extraction time of 20 min;the optimal extraction conditions of total flavonoids were 40% ethanol,particle size of 0.20 mm,extraction temperature of 30 ℃,liquid-solid ratio of 20,and extraction time of 20 min. In verification test,the contents of total polyphenol and total flavonoids in G. jasminoi-des were 1.70%(RSD=1.43%,n=3),3.23%(RSD=3.72%,n=3),with relative error of 1.80%,8.75% with predicted val-ues,respectively. CONCLUSIONS:The response surface method based on PB and CCD is simple,reasonable and feasible to opti-mize the extraction technology of total polyphenol and total flavonoids in G. jasminoides. The method can provide reference for its industrial extraction.
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Objective To investigate the etilolgy of failed pyeloplasty in children and to study the feasibility of redo laparoscopic surgery for recurrent nreterupelvic junction obstruction.Methods The clinical data of 39 patients with recurrent ureteropelvic junction obstruction after the primary pyeloplasty underwent redo laparoscopic surgery were analyzed retrospectively between September 2009 and June 2016 in our institution.There were 31 males and 8 females with a mean age of 66 months,ranged from 4 to 204 months.28 patients had left obstructions and 11 had fight obstructions,who were diagnosed by ultrasonography,MRU,and MAG3 renal scan et a1.Under general anesthesia,we identified that two patients (5.1％) had renal calices strictures,four patients (10.3％) had unsolved disease ureter and anastomotic strictures,two patients (5.1％) had adhesion band and anastomotic strictures,one patient had adhesion band,high ureteropelvic anastomosis and ureter torsion,and 30 (76.9％) patients had anastomotic strictures.Thirty-three patients underwent cdismembered pyeloplasty,five patients underwent onlay appendiculoureteroplasty and one patient underwent ureterocalicostomy.Results All surgeries were successfully completed without conversion.No intraoperative complication was encountered.One patient had persistent,frequent and intolerable flank pain with severe hydronephrosis after surgery,he subsequently underwent nephrectomy.One patient had persistent severe hydronephrosis which was repaired with on-lay appendiculoureteroplasty.One patient had anastomotic adhesion and balloon dilatation was performed with no further obstruction in follow up imaging.The rest of the patients got complete clinical or radiologic resolution.The successive rate was 36 of 39 (92.3％) at a mean follow up of 25 months (ranging 3-60 months).Conclusions Unsolved ureteric pathologies,anastomotic stricture,renal calices stricture,adhesion band,torsion of ureter and high ureteropelvic anastomosis all contribute to recurrent obstruction after the primary pyeloplasty.Laparoscopic redo pyeloplasty is safe and feasible for skilled surgeons.
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Objective To compare the advantages and disadvantages of 3D BRAVO and TRICKS for detecting cerebral venous sinus thrombosis (CVST) and to explore the MR scanning methods on CVST.Methods A retrospective analysis was conducted on 40 patients who were diagnosed with CVST in the Fourth Affiliated Hospital of Kunming Medical University from January 2011 to June,2014.All the patients underwent TRICKS scan and 3D BRAVO examination and were classified into 3 groups based on dural venous sinuses,deep cerebral vein and superficial cerebral vein.Detection rates of TRICKS and BRAVO were evaluated and the results were analyzed.Result Detection rates of dural venous sinuses by TRICKS and BRAVO were 98.0％ and 100％ respectively.Detection rates of deep cerebral vein were 92.9％ and 100％ respectively.No significant difference was found (P＞0.05).Detection rates of superficial cerebral vein were 66.7％ and 100％ respectively.Significant difference was found between the two (P＜0.05) Conclusion BRAVO technology can clearly demonstrate the details of CVST,especially in superficial cerebral vein.With the combination use of TRICKS sequences,it will be of higher diagnostic value.
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Acute kidney injury ( AKI) is a clinical syndrome associated with increased morbidity and mortality, and early recognition is critical .In an attempt to engage laypeople and non-experts,the term kidney attack has been introduced to refer to acute kidney injury (AKI),and AKI with functional loss and tubular damage can be diagnosed both with functional criteria ( CRIAKI, creatinine increase AKI ) and damage criteria ( NCRIAKI, non-creatinine increase AKI ) according to the most recent ADQI consensus .This comprehensive definition of Acute Kidney Syndromes may be a major advancement in terms of early referral , prevention of progression and therapeutic strategies for AKI .
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Objective To investigate the effect of esmolol on myocardial apoptosis and cardiac function in rats with sepsis .Meth‐ods Ninety six SD rats were randomly divided into sham group (n= 32 ,for sham operation) ,sepsis group (n= 32 ,sepsis model) and treatment group (n= 32 ,intravenous infusion with esmolol after sepsis modeling) .At 3 h ,6 h ,12 h ,24 h after operation ,sam‐ples were conserved to measure serum cardiac troponin I (cTnI) ,caspase‐3 ,cardiomyocytes apoptosis index ,and myocardial patho‐morphology was observed by optical microscope .At 24 h after operation ,echocardiography was performed .Results The serum cT‐nI ,caspase‐3 ,cardiomyocytes apoptosis index were increased significantly in sepsis group and treatment group compared with sham group (all P< 0 .05) .After using esmolol ,cTnI and cardiomyocytes apoptosis index were relatively decreased in treatment group compared with sepsis group at the four time‐points(all P < 0 .05) .Caspase‐3 of treatment group decreased at 12 h after operation compared with sepsis group (P< 0 .05) .Treatment group had a higher LVEF than sepsis group at 24 h(P< 0 .05) .Conclusion Es‐molol could inhibit myocardial apoptosis and mitigate the damage of cardiac function in rats with sepsis .The decrease in caspase‐3 may be the mechanism of anti‐apoptosis .
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Objective To observe the interfering effect of different doses of penehyclidine hydrochloride (PHC) on the mRNA expressions of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) in the lung tissue of rats with traumatic shock so as to investigate the protective role of PHC in secondary long injury following traumatic shock and the underlying mechanism.Methods The traumatic shock model was established.A total of 104 Wistar rats were randomly divided into four groups:control group,shock group,low dose PHC group ( P1 group) and high dose PHC group ( P2 group).At the beginning of resuscitation,the rats in P1 and P2 groups were given transjugular intravenous injection of 2 ml/kg isotonic saline containing 0.15 mg/kg and 0- 45 mg/kg PHC respectively,while the rats in shock and control groups were injected only isometric isotonic saline.The rats in the four groups were killed at 2 h,6 h,12 h and 24 h after resuscitation respectively to detect the mRNA expressions of NF-κB and iNOS by using RT-PCR and determine the lung wet/dry weight (W/D) ratio,lung permeability index (LPI) and lung injury score (LIS).Results The mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS at all the time intervals in the shock,P1 and P2 groups were all significantly increased as compared with those in the control group (P＜0.05).Howerver,the P2 group showed significant reduction in aspects of the mRNA expressions of NF- κB and iNOS,lung W/D ratio,LPI and LIS at all time points and P1 group also had significant decrease regarding the mRNA expressions of NF-κB and iNOS,lung W/D ratio at2 h,6 h,and LPI and LIS at 2 h,6 h,12 h,as compared with the shock group.Meanwhile,P2 group showed evident decrease at 6 h concerning the mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS as compared with P1 group (P ＜ 0.05 ).Conclusions PHC,especially at a large dosage,can significantly mitigate the long injury secondary to traumatic shock,and the mechanism may be associated with the inhibition of mRNA expressions of NF-κB and iNOS.
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Objective To investigate the relation of a lipopolysaecharide receptor CDl4C-159T gene polymorphism to severe sepsis outcome and cytokines in postoperative severe sepsis.Methods A prospective,consecutive entry study was made among 42 postoperative sevel'e sepsis admitted in neurosurgeon department,Second People～Hospital ShenZhen between Feb.2007 to Jul.2007.The genomie DNA of peripheral blood nucleated cells WaS extracted.CDl4-159C/T gene polymorphism patients was detected by restrictive fragment length polymorphism(RFLP)analysis.The relationship between genotypes and the production of eytokines TNF-α,IL-6,IL-10 and mortality rate of severe sepsis were evaluated.Results The mortality of sepsis in patients with CDl4 homozygous for the T allete(Tr)(69.2％)was significanfly higher than those with genotype CT(23.1％)and C allete(CC)(7.7％).In addition,TNF-a and IL-6 production ofTI'homozygore were markedly higher than those of the TC and CC genetypes.while IL-10 production were the lowest of the three(P<0.05).Conclusion The single base pair pelymorphism at position-159 in the CD14 gene promoter might influence the outcome of severe sepsis and may be related to production of pro-inflammatory cytokines TNF-α,IL-6,and decrease the anti-inflanunatiry factor IL-10.
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Objective To investigate the effects of glycine on the expression of HSP70 and TNF-α mRNA in the liver tissue of rats with traumatic shock and explore the protective mechanism of glycine a-gainst secondary liver injury after traumatic shock. Methods The traumatic shock model was established and 120 Wistar rats were divided randomly into three groups: treatment group, shock group and control group. At the beginning of resuscitation, the rats in the treatment were injected with 0.5 ml isotonic saline containing 100 mg/kg glycine, those rats in the shock group were injected only with 0.5 ml isotonic saline. The rats in three groups were killed at 3, 6, 12, 24 and 48 hours after resuscitation respectively. The ex-pression of HSP70 and TNF-α mRNA in the liver tissue were detected by RT-PCR, pathological changes were observed and serum ALT and AST were measured. Results The expressions of HSP70 and TNF-α mRNA in the liver tissue of rats in the shock group began to increase at 3 hours and both reached the peak value at 6 hours after resuscitation, but the expression of HSP70 mRNA in the treatment group reached the peak value at 12 hours after resuscitation. Compared with the control group, the expression of HSP70 mR-NA in the treatment group increased significantly and that of TNF-α mRNA decreased siganicantly, serum ALT and AST decreased and pathological damage was relieved significantly (all P < 0.05). Conclusion By enhancing the expression of HSP70 mRNA and decreasing the expression of TNF-α mRNA, glycine may play a protective role against the secondary damage of liver after traumatic shock.
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Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation (CPR) and validate its performance.Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation.A value was assigned to these variables.We used these variables in combination with APACHE Ⅱ/score to devise a multifactorial prediction score system,which we called PRCSs Prognostication Score (PRCSs-PS).Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS.Score of patients with different outcomes was compared.The area under the receiveroperating characteristic (ROC) curve was determined to evaluate performance of this tool to identify patients with a poor outcome (CPC4 and 5) and other outcomes (CPC1,2,and 3).Results There were differences of PRCSs-PS score among multiple groups with five different outcomes (CPC1-5)(F=65.91,P=0.000).Pairwise groups with different CPC were compared:no significant difference was noted between CPC 1 and CPC2 (12.41±6.49 vs 17.38±6.91,P=0.092),but difference between other pairwise CPC groups was statistically significant (CPC2 vs CPC3:17.38±6.91 vs 24.50±5.80,P=0.041,CPC3 vs CPC4:24.50±5.80 vs 32.29±5.24,P=0.006).The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows:it had 100% sensitivity,78.6% specificity,and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity,100% specificity and 176.4 diagnostic index at the score cut-off32.5.Score 23 and 33 were two key cut-offpoints.The area under the ROC curve was 0.968,showing excellent discrimination.Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.
الملخص
Objective To investigate the dynamic changes of HSP70 mRNA expression in the liver tissue of rats with traumatic shock and the treatment effects of glycine.Methods The expression of HSP70 mRNA in the liver tissue of treatment group,shock group and control group was detected by ELISA.Pathological changes were observed,and serum ALT and AST were measured.Results The expression of HSP70 mRNA in the liver tissue of rats in the shock group and the treatment group reached peak at the 6th and 12th hour after resuscitation respectively.Serum ALT and AST increased and pathological damage aggravated with time prolonging.Compared with control group,the expression of HSPT0 mRNA in treatment group increased significantly,serum ALT and AST decreased significantly and pathologi- cal damage was significantly relieved(all P<0.05).Conclusion Glycine can increase the expression of HSPT0 mRNA and relieve the secondary damage of liver after traumatic shock.
الملخص
Objective To investigate the relation of a lipopolysaccharide receptor CD14C-159T gene polymorphism to severe sepsis susceptibility and outcome in postoperation.Methods A prospective,consecutive entry study WSS made among 42 postoperative severe sepsis admitted in neurosurgeon,and 50 health volunteers.The genomic DNA of peripheral blood nucleated was extracted.Typing of each patient for the CD14-159C/T gene polymorphism was performed by restrictive fragment length polymorphism(RFLP).Genotypes were then related to the susceptibility and mortality rate of severe sepsis.Results Development of postoperative severe sepsis increased in patients homozygous for the allele T(78.4%)than that of the allele C(21.6%)(P＜0.05).The mortalitv of sepsis were significantly higher in patients with CD14 homozygous for the T allete(TT)(84.6%)than those with genotype TC (15.4%)and C ailetc(CC)(O).Conclusion The single base pair polymorphism at position-159 in the CD14 gene promoter might influence the development of severe sepsis as well as outcome in postopration.