Volume 86  ·   Issue 45  ·  2006

Objective to investigate the protective effect and mechanism of Kinadol on lung ischemia-reperfusion injury in donors undergoing lung transplantation. Methods a simulated rabbit lung autotopic transplantation model was established. The rabbits were divided into simple ischemia-reperfusion (I/R) group (n =6), modified LPD solution perfusion (LPD) group (n =6) and Kinadol treatment (LPD + E) group (n =6). The changes of oxygen partial pressure (PaO2) and serum tumor necrosis factor (TNF-α) were monitored. The left lung was measured for dry/wet weight ratio (D/W), malondialdehyde (MDA) content and myeloperoxidase (MPO) activity, and the pathological changes of lung tissues were observed under light microscope. Results (1) The PaO2 in the three groups decreased significantly at 15, 60 and 90 min after reperfusion, but the LPD + E group was significantly better than that in the I/R group 212.2 m Hg±53.9 mm Hg vs 122.5 mm Hg±20.7 mm Hg, 240.5 mm Hg±52.5 mm Hg vs 64.5 mm Hg±5.6 mm Hg, 236.5 mm Hg±51.1 mm Hg vs 100.0 mm Hg±8.6 mm Hg, P<0.01), LPD (2) The levels of TNF-α in I/R group and LPD group were higher than those before ischemia at each time point after reperfusion and 60 min and 90 min after reperfusion in LPD + E group, but the levels of TNF-α in LPD + E group were significantly lower than those in the other two groups (respectively 53.0 ng/L±6.2 ng/L vs 98.5 ng/L±2.8 ng/L, 86.9 ng/L±3.5 ng/L, 56.5 ng/L±6.3 ng/L vs 103.7 ng/L±4.4 ng/L, 90.2 ng/L±2.4 ng/L, P<0.05). (3) I/R The contents of MDA were 12.4 nmol/mg±1.1 nmol/mg, 9.9 nmol/mg±0.9 nmol/mg and 6.6 nmol/mg±0.7 nmol/mg, respectively, and the MPO activity was 14.85 U/g±1.40 U/g, 12.81 U/g±1.04 U/g and 10.38 U/g±1.07 U/g, respectively. P<0.01. (4) D/W ratio of lung tissue: 0.1309±0.0122, 0.1550±0.0096 and 0.1775±0.0073 in I/R group, LPD group and LPD + E group, respectively, P<0.01. (5) Pathological changes: In I/R group, lung tissue injury was severe, a large number of inflammatory cells infiltrated in the alveolar septum, inflammatory cells aggregated in the alveolar cavity, inflammatory fluid exudated, and patchy hemorrhage was observed, while in LPD + E group, the pathological changes were the slightest, inflammatory cells infiltrated and inflammatory fluid exudated were not significant.

Objective to investigate the feasibility and effectiveness of free mucosal patch to replace urethra. Methods Twenty adult male Beagle dogs were divided into groups A and B for the experiment. Group A was replaced with buccal mucosal patch, and group B was replaced with colon mucosal patch. The buccal mucosal patch and colon mucosal patch with a size of 4 cm ×0.8 cm were taken to replace the urethra of groups A and B, respectively. The urination status was observed after operation. Three months later, the dogs were subjected to retrograde urethrography, and the presence or absence of stenosis was confirmed by F8 probe. Then the dogs were sacrificed to measure the graft length and pathological histological examination was performed. Results All the experimental dogs survived, and all except 3 cases urinated smoothly. In group A, 1 case was found to have urethral stenosis, and another case had urinary fistula and bleeding. The average shrinkage rate of graft was 15.25% in group A and 13.75% in group B. All the transplanted buccal mucosa and colonic mucosa survived, most of the squamous epithelium of buccal mucosa was covered with pseudo-multilayer metastatic epithelial cells, and most of the glandular epithelium of colonic mucosa was covered with pseudo-multilayer metastatic epithelial cells.

Objective to investigate the effect and mechanism of recombinant human bone morphogenetic protein-2 (rhBMP-2) on pulmonary artery pressure (PPa) after endotoxin-induced acute lung injury. Methods Wistar rats were randomly divided into 3 groups, 20 rats in each group. Endotoxin (LPS) control group (Group L): 3 ml of normal saline was infused through femoral vein for 1 h, and then 1 mg/kg of LPS (dissolved in 2 ml of 0.9% normal saline) was infused, and the infusion was completed within 30 min; rhBMP-2 treatment group (LT group): 10 μ g/kg of rhBMP-2 was dissolved in 3 ml of 0.9% normal saline, infused through the femoral vein within 1 h, and then infused with LPS (the method is as above), and rhBMP-2 was single injected with 4 μ g/kg through an indwelling intravenous catheter at 24 h and 48 h after LPS infusion, respectively. The PPa of each group was measured at 72 h. After HE staining, the percentage of media thickness of pulmonary arterioles was measured by microscopic image analysis system; The proliferation and apoptosis of PASMC were detected by BrdU and TUNEL staining, respectively; Detection of delayed rectifier K + channel (KV) activity by patch clamp technique; The expression of Kv1.5 mRNA and protein was detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. Results the percentage of PPa and pulmonary arteriole media thickness in group L were significantly higher than those in group C and group LT (P<0.01). The mitotic index of PASMC in group L was significantly higher than that in group C and LT (P<0.01), while the apoptosis index was significantly lower than that in group LT (P<0.01); The activity of delayed rectifier K + channel (KV) and the expression levels of Kv1.5 mRNA and protein in group L were significantly lower than those in group C and LT (both P<0.05). Conclusion rhBMP-2 can inhibit the proliferation of pulmonary artery smooth muscle cells, promote their apoptosis, prevent the remodeling of pulmonary vascular configuration and inhibit the increase of PPa after endotoxin-induced acute lung injury. The mechanism may be related to the increase of delayed rectifier K + channel activity and the upregulation of Kv1.5 mRNA and protein expression.

Objective to investigate the characteristics of lymph node metastasis in thoracic esophageal carcinoma, guide lymph node dissection of esophageal carcinoma and provide evidence for the formulation of comprehensive postoperative treatment plan.Methods The surgical and pathological data of 623 patients with thoracic esophageal carcinoma admitted to the thoracic surgery department of Henan Cancer Hospital from January 2002 to December 2004 were retrospectively analyzed to analyze the characteristics of lymph node metastasis.Results A total of 3689 lymph nodes (8603) were dissected in the whole group, the lymph node metastasis rate was 47.2%, and the lymph node metastasis degree was 10.3%; There was no lymph node metastasis in Tis stage esophageal carcinoma, but lymph node metastasis was observed in all stages after T1 stage esophageal carcinoma. There were statistically significant differences in lymph node metastasis rate and metastasis degree among different T stage thoracic esophageal carcinoma (x2=38.407, P =0.000 and x2=118.438, P =0.000); The lymph node metastasis rate and metastasis degree increased with the increase of T stage, and there was a significant correlation between them (r =1,P =0.000; r =1,P =0.000); There was no statistically significant difference in lymph node metastasis among different pathological types of thoracic esophageal carcinoma (x2=6.284, P =0.179), but there was statistically significant difference in lymph node metastasis (x2=84.577, P =0.000). The lymph node metastasis rate and metastasis degree of esophageal adenosquamous carcinoma, adenocarcinoma and small cell carcinoma were significantly higher than those of esophageal squamous carcinoma; Lymph node metastasis of esophageal carcinoma is bidirectional and jumping; Abdominal lymph node metastasis can occur in all segments of esophageal carcinoma, and the metastasis rate and metastasis degree of abdominal lymph node in lower thoracic esophageal carcinoma are the highest. Conclusion Lymph node clearance should be moderate in esophageal carcinoma, and attention should be paid to abdominal lymph node clearance; On the basis of ensuring the relative thoroughness of the operation, according to the trend of lymph node metastasis and other indexes, it should be the direction of the treatment of esophageal cancer to receive reasonable multidisciplinary comprehensive treatment as soon as possible.

Objective to study the pathogenesis of the high tendency of cervical spondylotic myelopathy in patients with degenerative lumbar spinal stenosis and the intrinsic relationship between these two diseases.Methods A prospective study was performed to measure the cervical spinal canal on lateral cervical X-ray films of 68 patients with degenerative lumbar spinal stenosis, and the ratio of sagittal diameter of cervical spinal canal was calculated. Among them, 23 were males and 45 were females, aged 22-69 years, with an average age of 50.0 years. The results of sagittal diameter of cervical canal measured on lateral X-ray films of 411 normal subjects were taken as the control group, and the two groups were compared. Results The mean ratio of sagittal diameter of cervical spinal canal in patients with degenerative lumbar spinal stenosis was 0.781 for males and 0.807 for females, while the mean ratio of sagittal diameter of cervical spinal canal in normal control group was 0.874 for males and 0.968 for females. The ratio of sagittal diameter of cervical spinal canal (C3~ C7) in the patients with degenerative lumbar spinal stenosis was lower than that in the normal control group (all P<0.05). Developmental cervical spinal stenosis occurred in 27.9% of the patients with degenerative lumbar spinal stenosis, which was higher than that in the normal subjects (10%). Conclusion Compared with the normal subjects, the patients with degenerative lumbar spinal stenosis are more likely to develop developmental cervical spinal stenosis.

Objective to investigate the correlation between the changes of serum fatty acid binding protein (FABP) 4 concentration and sex hormones and blood lipids in patients with polycystic ovary syndrome (PCOS). Methods The serum levels of FABP 4 in 29 patients with PCOS and 14 normal controls were detected by ELISA, the serum levels of prolactin, luteinizing hormone, follicle stimulating hormone, estradiol and testosterone were detected by chemiluminescence, and the serum levels of androstenedione were detected by radioimmunoassay. The concentrations of triglyceride, total cholesterol, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) in serum were detected by automatic biochemical analyzer; Results the serum level of FABP4 in PCOS group was significantly higher than that in the normal control group [(24±15) ng/ml vs (9±8) ng/ml, P<0.01]. Univariate correlation analysis showed that the level of FABP4 was positively correlated with body mass index (r =0.621, P<0.01) and testosterone (r =0.658, P<0.05), and negatively correlated with HDL-C (r = -0.331, P<0.05). Partial correlation analysis showed that FABP4 was positively correlated with testosterone (r =0.507, P<0.01), but no significant correlation with other factors (P>0.05). Conclusion The increase of FABP4 in serum of PCOS patients may be related to hyperandrogenism in PCOS patients; FABP4 may be involved in the disorder of lipid metabolism in PCOS and the occurrence of long-term cardiovascular disease.

Objective to evaluate the long-term efficacy and influencing factors of enlarged thymectomy in the treatment of myasthenia gravis (MG). Methods From January 1990 to January 2006, 546 patients underwent enlarged thymectomy in the First Affiliated Hospital of Sun Yat-sen University were followed up. The efficacy was evaluated according to the clinical relative score method, which was divided into cured (remission), basically cured, markedly effective, improved (the above four items were called effective) and ineffective. The factors such as sex, age, disease course, clinical classification and thymic pathological type were statistically analyzed. Results The final follow-up number of 410 patients, 199 males and 211 females, were followed up from 6 months to 85 months, with an average of 29 months ± 18 months. The remission rate was 42.9%, and the effective rate was 82.3%. Logistic regression showed that the preoperative course of disease was less than 1 year, which was the protective factor affecting the postoperative efficacy (OR =0.310, P =0.006). Conclusion The postoperative remission rate and effective rate increased gradually with the prolongation of postoperative time. The sex, age, clinical classification and thymic pathological type of patients had no correlation with the efficacy. The shorter the preoperative course of disease, the better the postoperative efficacy.

Objective to investigate whether the upregulation of inducible nitric oxide synthase (iNOS) expression is involved in the degeneration of dopaminergic neurons induced by lipopolysaccharide (LPS). Methods 5 μ g of LPS was injected into the substantia nigra of rats, and the dynamic changes of iNOS mRNA and protein expression were observed at different time points (6, 12 h, 1, 3, 7 d). The dynamic changes of iNOS mRNA and iNOS protein increased at 6 h, reached a peak at 1 d, decreased at 3 d, and basically disappeared after 7 d. The number of iNOS positive cells (45.30±4.63) was significantly higher than that of PBS control (0.11±0.04) (P<0.01) at 1 d. The expression of iNOS mRNA and iNOS protein in 1 d group was significantly higher than that in normal control group and PBS control side by RT-PCR and Western blot; Conclusion the upregulation of iNOS may be one of the important factors in the mechanism of LPS-induced degeneration of DAERGIC neurons.

Objective to investigate the role of phosphorylation of protein kinase C δ isoform (PKC δ) in the death of dopaminergic neurons induced by 6-hydroxydopamine (6-OHDA), and to investigate the molecular pathogenesis of neuronal deletion in Parkinson's disease. Methods Dopaminergic neuronal cell line SH-SY5Y cells were cultured in vitro, and the effects of PKC inhibitor and activator on the toxicity of 6-OHDA were observed. The cell survival rate was observed by thiazole blue colorimetry, and the expression of phosphorylated PKC δ was observed by Western immunoblotting. Results the PKC δ inhibitor rottlerin 2 μ mol/L could inhibit the activation of PKC δ phosphorylation and reduce the cell death caused by 6-OHDA by about 57%±6% (P<0.01). The total PKC inhibitor Bisindolylmaleimide Ⅰ and the calcium-dependent PKC inhibitor G (o) 6976 did not affect the toxicity and PKC δ activation of 6-OHDA, while the PKC δ activator 100 nmol/L phorbol ester increased the phosphorylated PKC δ level and increased the phosphorylated PKC δ level. It suggests that PKC δ may play a role in neuronal deletion in patients with Parkinson's disease.

At present, most hospitals use the electronic pulse CO2 pneumoperitoneum machine in laparoscopic surgery. The problem that the pneumoperitoneum machine causes the pressure change in the abdominal cavity of patients during inflation has gradually attracted the attention of clinicians and related engineers and technicians [1,2]. In clinical practice, we found that the pressure of the electronic pulse pneumoperitoneum machine at the instant of inflation will be much higher than the set intraperitoneal pressure, which will cause adverse effects on patients. It is also reported that the inflation pressure of the electronic pulse pneumoperitoneum machine causes the change of peritoneal morphology [3,4]. Now, a constant pressure variable flow pneumoperitoneum machine has been invented. We used the pressure tester certified by Shanghai Institute of Metrology and Testing Technology to conduct inflation pressure test experiments on the pneumoperitoneum machine with two working principles respectively to explore the change of intraperitoneal pressure at the instant of inflation. The experimental results are reported as follows.

The patient was a 64-year-old male, a farmer in Guizhou Province. He was admitted to hospital on March 17, 2003 due to fever and cough for 20 days with aggravated pain in the liver area for 3 days. He was admitted to hospital 20 days before admission due to cough and fever. The chest radiograph of the outside hospital showed "infiltrating shadow in the right lower lobe". B-ultrasound showed that the acoustic area in the low gyrus area of the right liver was about 3.8 cm ×2.5 cm. WBC: 4.2×109/L, hemoglobin 70 g/L, average volume of red blood cells 106 fl, and platelets 75×109/L. The cough improved after anti-infection and anti-inflammatory treatment, vitamin B12 and folic acid support treatment.

Many rheumatic diseases tend to occur in women, and often occur in the childbearing age, and even aggravate during pregnancy and lactation, requiring drug treatment. However, at present, most drugs have not tested their effects on the fetus in the clinical trial stage before research and development or marketing, and their instructions are almost always marked with the words "prohibited or cautious use for pregnant women". This situation not only makes patients and their families at a loss when faced with the above problems, but even do not hesitate to terminate the pregnancy that is originally needed but can be preserved, but the lack of knowledge about medication during pregnancy and lactation also makes many medical workers in a dilemma. Therefore, we summarize the effects of the most commonly used anti-rheumatic drugs on pregnant and lactating women, and provide them with safe medication guidance.

How to maintain the graft patency rate after coronary artery bypass grafting (CABG) is an urgent clinical problem to be solved. Many factors are related to the graft patency rate. This paper summarizes the recent related literature.

diabetic foot (DF) is a common foot disease caused by neuropathy, peripheral vascular disease and infection. Among diabetic patients, the incidence of neuropathy is 15%, the incidence of peripheral vascular disease is 5%, the incidence of infection is 7.6%, and nearly 3% cases need amputation [1]. DF surgery has high healing rate, short course of treatment, few complications, low recurrence and infection rate, which has obvious advantages over conservative treatment [2]. DF surgery can be divided into two categories: limb salvage and limb amputation.

Case 1, 29 years old, was admitted to hospital due to menopause for 33+1 weeks, and was found to have lost weight for two weeks after prenatal examination. Two weeks before admission, he developed middle and upper abdominal pain, accompanied by nausea, anorexia and fatigue, which worsened at night. Pregnancy 1 and delivery 0, denying the history of hepatitis. Physical examination: blood pressure 118/80 mm Hg (1 mm Hg =0.133 kPa), pulse 81 beats/min, clear consciousness, moderate yellowing of skin and sclera, no abnormalities in heart and lung. Abdominal distension, mild tenderness in left upper abdomen, unpalpable liver and spleen, no percussion pain in liver area, negative Murphy's sign. Uterine height 25 cm, abdominal circumference 90 cm, fetal heart rate 140 beats/min. B-ultrasound: abnormal gallbladder echo, gallbladder polyps.

Uterine malformations are common female reproductive tract malformations, and the anatomical abnormalities of the uterus caused by malformations have been considered to be the root cause of pregnancy and pregnancy and obstetric complications [1,2]. In recent years, with the development of minimally invasive techniques and the popularization of clinical applications, hysteroscopy and laparoscopic surgery have become the routine diagnosis and treatment methods in gynecological clinics.We diagnosed and treated 24 cases of uterine malformations by hysteroscopy combined with laparoscopy, and achieved good clinical results, which are reported below.

Leptin is the coding product of obesity gene (OB) [1], which is synthesized by adipose tissue and secreted into the blood, and acts on the obesity gene (OB-R) of target cells to play a biological role. Current studies have shown that leptin is closely related to acute pancreatitis (AP), and plasma leptin is significantly increased during AP [2, 3]. The protective effect of leptin on bombesin-induced edematous pancreatitis (CIP) rats is related to inhibiting the release of pro-inflammatory mediators tumor necrosis factor α (TNF α) and interleukin-1 β (IL-1 β), activating nitric oxide (NO) pathway, improving pancreatic blood flow and promoting pancreatic cell growth [3-5]. This experiment investigated the protective effect of leptin and its receptor in severe acute pancreatitis (SAP).

At present, there are few studies on the use of aprotinin in off-pump coronary artery bypass grafting (OPCAB), and its effect on complement activation and leukocyte adhesion in patients with OPCAB is rarely reported at present. Therefore, two dosage regimens are proposed in this trial to evaluate the effect of aprotinin on perioperative inflammatory response in this group of patients, and to provide a reference for clinical determination of relatively appropriate dosage.

Antibiotic bone cement is widely used in the treatment of postoperative infection after artificial joint replacement. It has been found that the recurrence rate of postoperative infection can reach 10.4% and 15.1% when antibiotic bone cement is used between primary or secondary revision of total hip joint [1]. Low frequency ultrasound is used to control drug penetration into biological barrier [2]. The purpose of this study is to observe the antibacterial performance and safety of vancomycin-loaded bone cement (VLBC) under the action of low frequency continuous wave ultrasound (CWU).