[Intervention effect of Dachengqi Granule on apoptosis of small intestine smooth muscle cells in rats with multiple organ dysfunction syndrome].

OBJECTIVE: To observe the intervention of Dachengqi Granule (DG) on the apoptosis of small intestine smooth muscle cells (SMCs) in rats with multiple organ dysfunction syndrome (MODS) and its mechanisms. METHODS: Healthy 100 adult Wistar rats were randomly divided into the control group (n =20), the MODS model group (n =40), and the DG group (n =40).E. coli suspension was peritoneally injected to rats in the model group and the DG group to establish bacterial peritonitis induced MODS model. DG at 1 mL/100 g was administered by gastrogavage to rats of the DG group, twice daily for 3 successive days. Twenty-four hours after modeling, the proximal segment of intestine was taken and stained by using terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) and immunohistochemistry. Changes of apoptosis quantity of SMCs and the expression of Bcl-2 associated X protein (Bax), B cell lymphoma/leukemia-2 (Bcl-2) and cytochrome c protein (Cyt c) in mitochondrial apoptotic signaling pathway were observed. RESULTS: Compared with the control group, the apoptosis quantity of SMCs and the expression of Bax and Cyt c protein significantly increased, and the expression of Bcl-2 protein significantly decreased in the MODS model group (P <0.01). Compared with the MODS model group, the apoptosis quantity of SMCs and the expression of Bax and Cyt c proteins significantly decreased, and the expression of Bcl-2 protein significantly increased in the DG group (allP <0.01). CONCLUSION: DG could inhibit apoptosis of SMCs through suppressing activation of mitochondrial apoptotic signaling pathway in intestinal SMCs, thus promoting the recovery of the gastrointestinal motility function in rats with MODS.

[Repair of xiangsha liujunzi decoction on damage of interstitial cells of cajal and gap junction in the gastric muscular layer of rats of Pi-Qi deficiency syndrome: an experiment study].

OBJECTIVE: To explore the repair of Xiangsha Liujunzi Decoction (XSLJZD) on interstitial cells of Cajal (ICC) and gap junction (GJ) in the gastric muscular layer of rats of Pi-qi deficiency syn- drome (PQDS). METHODS: PQDS was established using purgative method with bitter and cold drugs in 30 healthy Wistar rats. After successful modeling they were randomly divided into the treatment group and the model group, 15 in each group. Another 15 healthy Wistar rats were recruited as the healthy control group. Rats in the treatment group were gastric administered with XSLJZD at 2 mL/100 g body weight, once daily for 14 successive days. Equal volume of normal saline was gastrically administered to those in the healthy control group and the model group. The gastric muscle tissues were taken out before modeling, before intervention, and after intervention, respectively. Ultrastructural changes of ICC and GJ were observed using transmission electron microscope (TEM). The number and distribution of Connexin43 (Cx43) were detected using immunohistochemistry. RESULTS: Results of TEM indicated that compared with the healthy control group, both ICC and GJ in the model group showed obvious injury. ICC and GJ were apparently repaired after intervention in the treatment group. Compared with the same group before modeling, the integrated optical density (IOD) of the Cx43 expression significantly decreased in the model group before and after intervention (P <0.05). Compared with before intervention, the IOD of the Cx43 expression significantly increased in the treatment group (P <0.05). Compared with the healthy control group, the IOD of the Cx43 expression significantly decreased in the model group before and after intervention (P <0.05). Compared with the model group, the IOD of the Cx43 expression significantly increased in the treatment group (P <0.05). CONCLUSIONS: Ultrastructures of ICC and GJ in the gastric muscular layer of rats of PQDS were obviously damaged. XSLJZD could repair the structural damage of ICC and GJ in the gastric muscle tissues of rats of PQDS.

Phosphocreatine promotes epigenetic reprogramming to facilitate glioblastoma growth through stabilizing BRD2.

Glioblastoma (GBM) exhibits profound metabolic plasticity for survival and therapeutic resistance, while the underlying mechanisms remain unclear. Here, we show that GBM stem cells (GSCs) reprogram the epigenetic landscape by producing substantial amounts of phosphocreatine (PCr). This production is attributed to the elevated transcription of brain-type creatine kinase (CKB), mediated by Zinc finger E-box binding homeobox 1 (ZEB1). PCr inhibits the poly-ubiquitination of the chromatin regulator bromodomain containing protein 2 (BRD2) by outcompeting the E3 ubiquitin ligase SPOP for BRD2 binding. Pharmacological disruption of PCr biosynthesis by cyclocreatine leads to BRD2 degradation and a decrease in its targets' transcription, which inhibits chromosome segregation and cell proliferation. Notably, cyclocreatine treatment significantly impedes tumor growth and sensitizes tumors to a BRD2 inhibitor in mouse GBM models without detectable side effects. These findings highlight that high production of PCr is a druggable metabolic feature of GBM and a promising therapeutic target for GBM treatment.

Suppression of Ribosome Biogenesis by Targeting WD Repeat Domain 12 (WDR12) Inhibits Glioma Stem-Like Cell Growth.

Glioma stem-like cells (GSCs) are a subset of tumor cells that initiate malignant growth and promote the therapeutic resistance of glioblastoma, the most lethal primary brain tumor. Ribosome biogenesis is an essential cellular process to maintain cell growth, but its regulatory mechanism in GSCs remains largely unknown. Here, we show that WD repeat domain 12 (WDR12), a component of the Pes1-Bop1 complex (PeBoW), is required for ribosome biogenesis in GSCs. WDR12 is preferentially expressed in GSCs compared to non-stem tumor cells and normal brain cells. High levels of WDR12 are associated with glioblastoma progression and poor prognosis. Silencing WDR12 results in the degradation of PeBoW complex components and prevents the maturation of 28S rRNA, thereby inhibiting ribosome biogenesis in GSCs. Subsequently, WDR12 depletion compromises GSC proliferation, inhibits GSC-derived orthotopic tumor growth, and extends animal survival. Together, our results suggest that WDR12 is crucial for ribosome biogenesis in GSCs, and is thus a potential target for GSC-directed therapy of glioblastoma.

[Comparison of laparoscopic exploration and exploratory laparotomy in the diagnosis and treatment of abdominal open trauma].

OBJECTIVE: To explore the clinical effect of laparoscopic exploration in the diagnosis and treatment of abdominal open trauma. METHODS: Patients with abdominal open trauma admitted to the First Affiliated Hospital of Dalian Medical University from August to December in 2018 were enrolled. According to different exploration methods, 11 patients undergoing laparoscopic exploration were grouped into laparoscopy group and 20 patients undergoing exploratory laparotomy were grouped into laparotomy group. The operation time, the length of hospital stay, cases without abdominal visceral injury, postoperative exhaustion time, cases with complications and incision length were compared between the two groups. RESULTS: All the 31 patients were experienced with knife stab wound, with 26 males and 5 females, and the age was (33.39±11.47) years old. Compared with the laparotomy group, the length of hospital stay was significantly shorted in the laparoscopy group (days: 6.64±2.94 vs. 11.65±5.62), the postoperative exhaustion time was significantly decreased (hours: 40.36±29.04 vs. 75.60±42.84), the cases with complication was significantly decreased (case: 1 vs. 9), the incision length was significantly shorted (cm: 5.50±5.14 vs. 16.95±5.28), all of which results had statistical significance (all P < 0.05). The operation time of laparoscopy group was shorter than that of laparotomy group (hours: 2.18±0.87 vs. 2.61 ±1.28), but without significant difference (P > 0.05). Confirmed by surgical exploration, 5 patients had no abdominal visceral injury, with 3 in the laparoscopy group and 2 in the laparotomy group, and the result had no significant difference between the two groups (P > 0.05). CONCLUSIONS: For patients with abdominal open trauma, laparoscopic exploration is helpful for diagnosis as quickly as possible, with less trauma and reduction of complications incidence, and is conducive to postoperative rehabilitation.

Clinical and molecular analysis of hereditary non-polyposis colorectal cancer in Chinese colorectal cancer patients.

AIM: To analyze the frequency of hereditary non-polyposis colorectal cancer (HNPCC) in Chinese colorectal cancer (CRC) patients, and to discuss the value of microsatellite instability (MSI) and/or immunohistochemistry (IHC) for MSH2/MLH1 protein analysis as pre-screening tests in China. METHODS: The Amsterdam criteria I and II (clinical diagnosis) and/or germline hMLH1/hMSH2 mutations (genetic diagnosis) were used to classify HNPCC families. Genetic tests, including microsatellite instability, immunohistochemistry for MSH2/MLH1 proteins and hMSH2/hMLH1 genes, were performed in each proband. RESULTS: From July 2000 to June 2004, 1988 patients with colorectal cancer were analysed and 114 CRC patients (5.7%) from 48 families were categorized as having HNPCC, including 76 from 26 families diagnosed clinically and 38 from the other 22 families diagnosed genetically. The sensitivity and specificity of high MSI and IHC for predicting mutations were 100% and 54%, and 79% and 77%, respectively. CONCLUSION: The frequency of HNPCC is approximately 10% among all Chinese CRC cases. The MSI and IHC detections for hMSH2/hMLH1 proteins are reliable pre-screening tests for hMLH1/hMSH2 germline mutations in families suspected of having HNPCC.

[Role of polymorphonuclear neutrophil apoptosis and expression of Fas and caspase-3 in the systemic inflammatory response syndrome].

OBJECTIVE: To study the role of the polymorphonuclear neutrophil (PMN) apoptosis and expression of Fas and caspase-3 in the systemic inflammatory response syndrome (SIRS). METHODS: Eight acute pancreatitis patients with SIRS, 6 healthy control subjects were enrolled to study apoptosis of PMN in peripheral blood samples, expression of Fas/Fas ligand (FasL) and caspase-3 in the PMN, the levels of serum interleukin-6 (IL-6) and IL-8 were observed. RESULTS: Spontaneous apoptosis was significantly delayed in PMN from the SIRS patients with higher serum IL-6 and IL-8 levels compared with controls (both P<0.01). PMN apoptosis rate in peripheral blood of patients with SIRS was lowered than that of controls (P<0.01). The expressions of Fas and caspase-3 in the peripheral circulating PMN were higher in the controls than those in the SIRS patients (both P<0.01). Serum FasL expression was not found by Western blotting 24 hours after culture of PMN in vitro. CONCLUSION: Peripheral circulating PMN from acute pancreatitis patients with SIRS show delayed apoptosis, decreased expressions of Fas and caspase-3, and prolonged PMN survival may contribute to the development of systemic inflammatory injury characteristic of SIRS.

Endovascular stenting of spontaneous isolated dissection of the superior mesenteric artery: A case report and literature review.

RATIONALE: Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare arterial disease that is difficult to differentiate from other diseases because of lack of specific clinical manifestation and for which there is no available optimal management strategy. PATIENT CONCERNS: A 58-year-old male patient visited our emergency room with sudden onset of moderate-severe epigastric abdominal pain of uncertain cause. DIAGNOSES: Computed tomography scanning showed a characteristic "double lumen sign" of the superior mesenteric artery, and further computed tomography angiography findings revealed a dissected segment of the superior mesenteric artery. INTERVENTIONS: Conservative management was administered for 5 days, but the abdominal pain remained. Subsequently, an endovascular stent was placed in the affected superior mesenteric artery. Postoperative antiplatelet therapy was administered for 6 months. OUTCOMES: The abdominal pain was relieved. Six months later, a follow-up of computed tomography angiography showed that the stent placed had no interval narrowing. LESSONS: Based on our review and the illustration of this case, endovascular stenting may be a preferred rescue treatment in SID-SMA patients for whom initial conservative treatment fails.

Changes in the Interstitial Cells of Cajal and Immunity in Chronic Psychological Stress Rats and Therapeutic Effects of Acupuncture at the Zusanli Point (ST36).

Now, chronic psychological stress (CPS) related diseases are increasing. Many CPS patients have gastrointestinal complaints, immune suppression, and immune imbalance. Increasing evidence is indicating that acupuncture (AP) at the Zusanli point (ST36) can alleviate functional gastrointestinal disorders (FGID), immune suppression, and immune imbalance. However, few studies have investigated the potential mechanisms. In this study, CPS rat models were established, and electroacupuncture (EA) at ST36 was done for CPS rats. Daily food intake, weight, intestinal sensitivity, the morphology of interstitial cell of Cajal (ICC) in the small intestine, and serum indexes were measured. The study found that, in CPS rats, EA at ST36 could improve food intake, weight, visceral hypersensitivity, and immunity; in CPS rats, in small intestine, the morphology of ICCs was abnormal and the number was decreased, which may be part causes of gastrointestinal motility dysfunction. EA at ST36 showed useful therapeutic effects. The mechanisms may be partially related to its repairing effects on ICCs damages; in CPS rats, there were immune suppression and immune imbalance, which may be part causes of visceral hypersensitivity. EA at ST36 showed useful therapeutic effects. The mechanisms may be partially related to its regulation on immunity.

[Apoptosis of interstitial cells of Cajal in deep muscular layer of small intestine in rats with multiple organ dysfunction syndrome].

OBJECTIVE: To observe the apoptosis of interstitial cells of Cajal in deep muscular layer (ICC-DMP) of small intestine in rats with multiple organ dysfunction syndrome (MODS) as a result of bacterial peritonitis, and the expression of c-kit (an ICC phenotype marker) and Bax/Bcl-2, in order to investigate the mechanism of gastrointestinal motility dysfunction in MODS. METHODS: According to the random number table, 40 Wistar rats were randomly divided into two groups: control group (n=20) and MODS group (n=20). The MODS model in rats was reproduced by intraperitoneal injection of 8×10(8) cfu/mL Escherichia coli suspension 1 mL, and the control group was given the same amount of normal saline. After 24 hours, the upper small intestine was harvested for examination. Ultrastructure of ICC-DMP was observed using electron microscope. The network structure of ICC-DMP and the expression of c-kit and Bax/Bcl-2 were observed and determined with immunofluorescence and laser scanning confocal microscope. RESULTS: Macroscopic observation revealed that the gastrointestinal motility of rats was normal in the control group. Compared with the control group, gastro intestine was significantly expanded with parulytic ileus in MODS group. It was shown by transmission electron microscopy that intermediate filament structure of ICC-DMP was clear without swelling of mitochondria; chromatin distributed uniformly with small amounts of heterochromatin aggregated in perinuclear. Compared with the control group, intermediate filament structure of ICC-DMP was fuzzy, and mitochondria were swollen obviously in MODS group; chromatin was assembled in nucleus centre. It was shown by laser scanning confocal microscope that the network structure of ICC-DMP was clear, the expression of c-kit and Bcl-2 was strongly and overlapping; the expression of Bax was weak and scatter distributed. Compared with control group, ICC-DMP quantity in MODS group was significantly reduced (cells/HP: 15.80±2.30 vs. 25.70±3.97, t=6.819, P=0.000 ), and ICC network was incomplete. The expression of c-kit and Bcl-2 was significantly decreased as compared with control group [ c-kit (fluorescence intensity): 129.56±36.90 vs. 307.23±40.07, t=10.314, P=0.000; Bcl-2 (fluorescence intensity): 103.23±25.19 vs. 378.92±43.79, t=17.259, P=0.000], whereas, the expression of Bax was significantly increased (fluorescence intensity: 270.94±36.98 vs. 92.57±20.92, t=-13.277, P=0.000 ). CONCLUSIONS: The mechanism of gastrointestinal motility dysfunction in MODS maybe closely related to ultrastructural damage of ICC-DMP, changes of c-kit phenotypic and activation of mitochondrial apoptosis pathway.

[Mitigation of the damage of intestinal smooth muscle of rats with multiple organ dysfunction syndrome by Dachengqi decoction through mitochondrial pathway].

OBJECTIVE: To discuss the mechanism of promotion of gastrointestinal motility during multiple organ dysfunction syndrome (MODS) by Dachengqi decoction, by examining the expression of Bcl-2, Bax of mitochondrial pathway, and nuclear factor-ΚB (NF-ΚB) in smooth muscle of the small intestinal in rats. METHODS: According to the random number table, 100 healthy adult Wistar rats were divided into three groups: control group with 20 rats, model group with 40 rats, and Dachengqi decoction group with 40 rats. Rat model of MODS was reproduced by bacterial peritonitis induced by an injection of 1 mL Escherichia coli suspension (8×10(8) cfu/mL) into peritoneal cavity. The rats in control group were given 1 mL normal saline intraperitoneally. The rats in Dachengqi decoction group were given 10 mL/kg Dachengqi decoction by gavage, twice a day, before inoculation of the bacterial suspension. Twenty-four hours after modelling, rats in all groups were sacrificed by cervical vertebra luxation, and the upper small intestine was harvested to detect the protein expressions of Bcl-2, Bax, and NF-ΚB in smooth muscle tissue using immunohistochemical staining. RESULTS: In the control group, a large amount of Bcl-2 protein was expressed and it was distributed uniformly in small intestinal smooth muscle. On the other hand, a small amount of Bax and NF-ΚB protein was expressed, and they were also distributed uniformly. Compared with the control group, Bcl-2 protein was distributed only sparsely, and it was scattered in intestinal smooth muscle in blocks in the model group. The expression of Bcl-2 protein was obviously down-regulated [integral optical density (A) value: 7 115.3±1 797.2 vs. 22 085.5±4 892.2, P < 0.05], and this phenomenon was more prominent in circular muscle layer. Bax and NF-ΚB were densely distributed, and their expressions were upgraded obviously [Bax (A value): 33 802.6±5 778.0 vs. 7 984.4±1 804.5, NF-ΚB (A value): 2 465.9±664.8 vs. 1 572.6±256.0, both P < 0.05]. This phenomenon was more outstanding in circular muscle layer. Compared with that of the model group, the expression of Bcl-2 protein was stronger obviously in intestinal smooth muscle in Dachengqi decoction group (A value: 12 458.6±2 491.1 vs. 7 115.3±1 797.2, P < 0.05). The expressions of Bax and NF-ΚB were down-regulated obviously [Bax (A value): 12 529.2±2 018.5 vs. 33 802.6±5 778.0, NF-ΚB (A value): 1 843.1±373.6 vs. 2 465.9±664.8, both P < 0.05], and the change was more obvious in circular muscle layer. CONCLUSIONS: Dachengqi decoction may promote recovery of gastrointestinal motility through an increase of Bcl-2 expression in nuclear membrane, thus preventing translocation of Bax to mitochondrion, thereby reduces mitochondrial damage in MODS.

Roles of PD-1, Tim-3 and CTLA-4 in immunoregulation in regulatory T cells among patients with sepsis.

OBJECTIVE: This study aims to elucidate the roles of PD-1, Tim-3 and CTLA-4 in sepsis. METHODS: Sepsis patients (n = 182) were selected as sepsis group and divided into three subgroups: mild sepsis group, severe sepsis group and septic shock group; 185 healthy volunteers were enrolled as control group. Flow cytometry and blood routine examination were performed for T lymphocytes and surface co-stimulatory molecules expressions. Pearson correlation test was applied for the correlation of co-stimulatory molecules expressions on T lymphocytes with critical illness in sepsis. Logistic regression analysis was conducted for risk factors in sepsis. RESULTS: Heart rate and WBC in subgroups were higher than control group (P < 0.05). The differences in APACHE II, SAP II and SOFA score among subgroups were statistically significant (P < 0.05). Compared with control group, lymphocyte ratio and percentage of CD4(+) T cells reduced in subgroups (P < 0.05). The differences in expression levels of CD4(+)PD-1(+), CD8(+)PD-1(+), and CD8(+)CTLA-4(+) showed statistical significances (P < 0.05). Apparently, expression levels of CD4(+)TIM-3(+), CD8(+)TIM-3(+), CD4(+)PD-1(+), CD8(+)PD-1(+), and CD4(+)CTLA-4(+) were positively correlated with APACHE II score (all P < 0.05). Logistic regression analysis showed that heart rate and expression level of CD4(+)PD-1(+) might be risk factors while the percentage of CD4(+) T cells might be a protective factor for sepsis (P < 0.05). CONCLUSION: PD-1 aggravates immune responses consistent with promotion of T cell exhaustion in sepsis. Expression level of CD4(+)PD-1(+) and heart rate are potential risk factors while percentage of CD4(+) T cells is a possible protective factor for sepsis.

Interventional effects of da-cheng-qi decoction on enteric nerve system in a rat model of multiple organ dysfunction syndrome.

In this study, we investigate the morphologic changes of enteric nerve system (ENS) and the expression of neurotransmitters, acetylcholine (ACh), substance P (SP), vasoactive intestinal peptide (VIP) and nitric oxide synthase (NOS), in small bowel of rats undergoing multiple organ dysfunction syndrome (MODS). Undergoing MODS, fluorescence integral optical density (IOD) value of enteric nerve fibers were significantly decreased (P<0.05), and the network structure of ENS was destroyed. The expression of ACh, SP, VIP and NOS was inhibited, IOD value of the four neurotransmitters was significantly decreased (P<0.05). After intervention of DCQD, the fluorescence IOD value of enteric nerves were significantly increased (P<0.05), and the network structure of ENS was repaired. The expression of ACh, SP, VIP and NOS was recovered, fluorescence IOD value of the four neurotransmitters was significantly increased (P<0.05). In conclusion, the gastrointestinal motility disorders undergoing MODS may be closely related to the morphology destroy of ENS and down regulation of neurotransmitters (ACh, SP, VIP and NOS) expression. DCQD could promote gastrointestinal motility through protecting the morphology of ENS and up regulation of neurotransmitters (ACh, SP, VIP and NOS) expression.

Effects of Dachengqi Decoction () on morphological changes in enteric nerve system of rats with multiple organ dysfunction syndrome.

OBJECTIVE: To observe the morphological changes in enteric nerve system (ENS) of rats with multiple organ dysfunction syndrome (MODS) treated by Dachengqi Decoction (, DCQD). METHODS: Fifty Wistar rats were randomly assigned to the control group, MODS model group and DCQD treated group. The rats in MODS model group and DCQD treated group were injected Escherichia coli (E. coli) suspension into abdominal cavity under sterile condition. The DCQD treated group was gavaged with DCQD 2 days before the E. coli suspension was injected. Twenty-four hours after injection, the proximal segment of intestine was resected and studied by immunohistofluorescence using vesicular acetylcholine transporter, vasoactive intestinal polypeptide (VIP), substance P (SP) and neuronal nitric oxide synthase (nNOS) antibodies. The whole-mount preparations were observed by laser scanning confocal microscope to detect the changes of quantity and fluorescence integral optical density (IOD) value of intestine enteric nerves. RESULTS: Compared with the control group, the quantity and IOD value of acetylcholine (ACh), VIP, SP and nitric oxide (NO) nerves of intestine in the MODS group were significantly decreased (P<0.01), and the network of enteric nerves was remarkably disrupted. Compared with the MODS group, the quantity and fluorescence IOD value of ACh, VIP, SP and NO nerves in the DCQD group were significantly increased (P<0.01), and the network of enteric nerves was remarkably recovered. CONCLUSION: DCQD can protect and repair damage in the network of ACh, SP, NO and VIP nerves in rats with MODS, which may be one of mechanisms involved in promoting gastrointestinal motility by DCQD.

Relationship of serum mannose-binding lectin levels with the development of sepsis: a meta-analysis.

Many studies have evaluated the association between serum levels of mannose-binding lectin (MBL) and sepsis; however, the findings are inconclusive and conflicting. For a better understanding of MBL in sepsis, we conducted a comprehensive meta-analysis. Potential relevant studies were identified covering Science Citation Index, the Cochrane Library, PubMed, Embase, CINAHL, and Current Contents Index databases. Two reviewers extracted data and assessed studies independently. Statistical analyses were conducted with the version 12.0 STATA statistical software. Ten papers were collected for meta-analysis. Results identified that sepsis patients had considerably lower MBL level than those in the controls (standardized mean difference (SMD) = 1.59, 95 % confidence interval (95%CI) = 0.86∼2.31, P < 0.001). Ethnicity-subgroup analysis showed that sepsis patients were associated with decreased serum MBL level in contrast to the healthy controls in Asians (SMD = 3.07, 95%CI = 1.27∼4.88, P = 0.001) and Caucasians (SMD = 1.00, 95%CI = 0.35∼1.65, P = 0.003). In the group-stratified subgroup analysis, subjects with lower serum MBL level did underpin susceptibility to sepsis in the infants subgroup (SMD = 2.57, 95%CI = 1.59∼3.55, P < 0.001); however, this was not the case in the adults subgroup (SMD = 0.13, 95%CI = -1.30∼1.55, P = 0.862). Our study suggests an important involvement of serum MBL level in sepsis patients considering their lower level compared to controls, especially among infants.

[An analysis of prognostic factors in patients suffering from acute lung injury/acute respiratory distress syndrome complicated with Yangming Fushi syndrome: a report of 206 cases from multiple centers].

OBJECTIVE: To investigate the risk factors of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) complicated with Yangming Fushi syndrome. METHODS: A prospective study was conducted. From August 2009 to July 2013, 206 patients with Yangming Fushi syndrome combined with ALI/ARDS were enrolled in the intensive care units (ICUs) of the following five hospitals: Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluation II (APACHEII) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy (CRRT), amount of blood transfusion, the level of C-reactive protein (CRP), lactulose/mannitol (L/M) ratio, the number of organs with dysfunction, oxygenation index (PaO2/FiO2), levels of lactate and serum creatinine (SCr) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients. RESULTS: There were 124 cases with severe acute pancreatitis (SAP), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU, 171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age (years: 57.26±16.23 vs. 48.07±13.48, t=3.544, P=0.000), APACHEII score (20.83±9.73 vs. 12.61±6.63, t=4.777, P=0.000), the length of invasive mechanical ventilation (days: 10.97±7.71 vs. 6.91±2.48, t=2.555, P=0.015) and the number of dysfunction organs (3.11±1.21 vs. 1.60±1.34, t=6.222, P=0.000) in death group were significantly higher. The level of PaO2/FiO2 [mmHg (1 mmHg=0.133 kPa): 218.56±64.90 vs. 244.58±85.10, t=-2.024, P=0.044] in the death group was significantly lower than that of the survival group, while the length of ICU stay (days: 14.33±10.81 vs. 9.11±7.37, t=2.600, P=0.010), the usage rates of CRRT [28.57% (10/35) vs. 15.20% (26/171), χ2=3.968, P=0.046], vasoactive agents [28.57% (10/35) vs. 12.28% (21/171), χ2=6.511, P=0.011], and blood transfusion ratio [42.86% (15/35) vs. 23.39% (40/171), χ2=7.042, P=0.008] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups (all P>0.05). Multivariate logistic regression analysis showed that age [ odds ratio (OR)=0.938, 95% confidence interval (95%CI)=0.898-0.980, P=0.004], APACHE II score (OR=0.914, 95%CI=0.839-0.996, P=0.041), the number of dysfunction organs≥3 (OR=0.223, 95%CI=0.066-0.754, P=0.016), and the level of PaO2/FiO2 (OR=0.990, 95%CI=0.982-0.998, P=0.015) were independent risk factors for mortality. CONCLUSIONS: The age, APACHE II score, number of dysfunction organs≥3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.

Serum S100B level may be correlated with carbon monoxide poisoning.

OBJECTIVE: To investigate the correlation between serum S100B level and carbon monoxide (CO) poisoning by meta-analysis. METHODS: By searching both English and Chinese language-based electronic databases (PubMed, EBSCO, Ovid, Springerlink, Wiley, Web of Science, Wanfang databases, China national knowledge infrastructure (CNKI), VIP database, etc.) thoroughly, we tabulated and analyzed the collected data with the use of Comprehensive Meta-analysis 2.0 (CMA 2.0). RESULTS: Totally 108 studies have been searched initially (92 studies in Chinese, 16 studies in English). Nine case-control studies (4 studies in English, 5 in Chinese) were chosen for an updated meta-analysis including 542 patients with CO poising and 236 healthy controls. Results identified that the serum S100B level were obviously higher than that in healthy controls (SMD=1.600, 95% CI=1.055-2.145, P<0.001). A subgroup based on the ethnicities revealed that the serum S100B level in Caucasian and Asian subgroups was clearly higher than serum S100B level in healthy controls (Asians: SMD=2.0624, 95% CI=1.736-3.511, P<0.001; Caucasians: SMD=0.447, 95% CI=0.197-0.697, P<0.001). CONCLUSION: Serum S100B level may be correlated with the CO poisoning and could be effective biomarker for early diagnosis and treatment monitoring in CO poisoning.

Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation.

AIM: To determine the efficacy and long-term outcome of biofeedback treatment for chronic idiopathic constipation and to compare the efficacy of two modes of biofeedback (EMG-based and manometry-based biofeedback). METHODS: Fifty consecutive contactable patients included 8 cases of slow transit constipation, 36 cases of anorectic outlet obstruction and 6 cases of mixed constipation. Two modes of biofeedback were used for these 50 patients, 30 of whom had EMG-based biofeedback, and 20 had manometry-based biofeedback. Before treatment, a consultation and physical examination were done for all the patients, related information such as bowel function and gut transit time was documented, psychological test (symptom checklist 90, SCL90) and anorectic physiological test and defecography were applied. After biofeedback management, all the patients were followed up. The Student's t-test, chi-squared test and Logistic regression were used for statistical analysis. RESULTS: The period of following up ranged from 12 to 24 months (Median 18 months). 70 % of patients felt that biofeedback was helpful, and 62.5 % of patients with constipation were improved. Clinical manifestations including straining, abdominal pain, bloating, were relieved, and less oral laxative was used. Spontaneous bowel frequency and psychological state were improved significantly after treatment. Patients with slow and normal transit, and those with and without paradoxical contraction of the anal sphincter on straining, benefited equally from the treatment. The psychological status rather than anorectal test could predict outcome. The efficacy of the two modes of biofeedback was similar without side effects. CONCLUSION: This study suggests that biofeedback has a long-term effect with no side effects, for the majority of patients with chronic idiopathic constipation unresponsive to traditional treatment. Pelvic floor abnormalities and transit time should not be the selection criteria for treatment.

Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases.

AIM: To analyze the causes and management of hemorrhage in spontaneous liver rupture. METHODS: Seventy cases of spontaneous liver rupture were retrospectively analyzed for causes of hemorrhage and therapeutic effects of surgical approaches. RESULTS: It was demonstrated that the causes of spontaneous liver rupture were primary liver cancer in 60 cases (85.7 %), cirrhosis in 3 cases (4.3 %), liver angioma in 2 cases (2.9 %), liver adenoma in 4 cases (5.7 %),and secondary liver cancer in 1 case (1.4 %). Hemostasis was achieved with surgical approaches in 68 cases (97.1 %) and non-surgical approaches in 2 cases (2.9 %). Surgical interventions included suture, ligation of hepatic artery, hepatic artery chemoembolization and partial hepatic resection. CONCLUSION: The results suggest that surgical intervention is still the main therapeutic method and the best procedure that should be selected according to causes of disease and patient's condition and history.

Signal pathways involved in emodin-induced contraction of smooth muscle cells from rat colon.

AIM: To investigate the effects induced by emodin on single smooth muscle cells from rat colon in vitro, and to determine the signal pathways involved. METHODS: Cells were isolated from the muscle layers of Wistar rat colon by enzymatic digestion. Cell length was measured by computerized image micrometry. Intracellular Ca2+ ([Ca2+]i) signals were studied using the fluorescent Ca2+ indicator fluo-3 and confocal microscopy. PKCalpha distribution at rest state or after stimulation was measured with immunofluorescence confocal microscopy. RESULTS: (1) Emodin dose-dependently caused colonic smooth muscle cells contraction; (2) emodin induced an increase in intracellular Ca2+ concentration; (3) the contractile responses induced by emodin were respectively inhibited by preincubation of the cells with ML-7 (an inhibitor of MLCK) and calphostin C (an inhibitor of PKC); (4) Incubation of cells with emodin caused translocation of PKCalpha from cytosolic area to the membrane. CONCLUSION: Emodin has a direct contractile effect on colonic smooth muscle cell. This signal cascade induced by emodin is initiated by increased [Ca2+]i and PKCalpha translocation, which in turn lead to the activation of MLCK and the suppression of MLCP. Both of them contribute to the emodin-induced contraction.