Volume 87  ·   Issue 19  ·  2007

There are two concepts of lung protection: narrow lung protection refers to the protection of the donor lung during lung or heart-lung transplantation, so as to exert normal function on the recipient, while broad lung protection refers to the prevention and treatment of lung injury caused by various causes, so as to maintain normal lung function of patients.

Acute renal failure (ARF) is a serious perioperative complication of critically ill patients, and rarely exists alone. It often occurs in severe patients with multiple organ insufficiency or failure, and the mortality rate is much higher than that of general medical renal failure.

1. Incidence rate of perioperative central nervous system injury Perioperative period refers to a period of time during and after operation, and there is no uniform definition of how long after operation is the perioperative period. In foreign countries, this period refers to 3~30 days after operation, but there is no uniform regulation in China.

In October 1998, China ended the history of no blood donation law for 1.3 billion people. The Ministry of Health enacted in 2000<Technical specification for clinical blood transfusion>.

Objective to investigate the effects of mild hypothermia after total ischemia on brain endogenous neuroprotection.Methods Fifteen healthy mongrel dogs were randomly divided into three groups: control group (Group A, n =4), ischemia-reperfusion group (Group B, n =5) and mild hypothermia treatment group (Group C, n =6). After cardiac arrest for 18 min and successful cardiac resuscitation, the animals in group B were observed for 8 h, and the animals in group C were treated with mild hypothermia [(34 ± 0.5) ℃]. At the end of the experiment, the right parietal cortex was taken by craniotomy to measure the contents of superoxide dismutase (SOD), glutathione (GSH) and glutathione peroxidase (GSH-Px). Immunohistochemical method showed that the positive neurons of parvulin (PV) and heat shock protein 70 (HSP70) were observed. Results The number of positive neurons of GSH, GSH-Px, T-SOD, MN-SOD, Cu-ZnSOD and PV in group B was significantly lower than that of group A (P<0.05 or P<0.01), while the number of positive neurons of HSP70-LI was significantly higher than that of group A [(15.6 ± 3.7) vs (5.5 ± 2.1), P<0.05]. The number of positive neurons of GSH, T-SOD, Cu-ZnSOD, PV and HSP70-LI in group C was significantly higher than that of group B (34.7 ± 6.3) vs

Objective to observe the effect of lidocaine on the neuronal regeneration of hippocampal dentate gyrus in chronically stressed adult mice and its mechanism.Methods Twenty-four adult male Kunming mice weighing about 16~26 g were randomly divided into three groups (n =8): (1) normal control group (group C): only normal saline was injected without stress stimulation; (2) Chronic stress group (group S): after daily injection of physiological saline, they received alternating stimulation of different stressors; (3) Chronic stress combined lidocaine treatment group (Group L): after daily injection of lidocaine, they received alternating stimulation of different stressors; After 14 d of repeated stress, 5-bromodeoxyuracil (BrdU) was injected to label the cells in the differentiation stage.At the end of the experiment, the adrenal glands of mice were stained with HE, and the frozen sections of the hippocampus were taken to observe the BrdU positive cells and brain-derived neurotrophic factor (BDNF) in different groups of mice by immunohistochemistry.Results Compared with group C, the adrenal cortex of mice in group S was irregular and the medulla structure was unclear; BrdU-labeled newborn cells and brain-derived nerve growth factor decreased in hippocampal dentate gyrus (P<0.05); There was no significant difference between group L and group C (P>0.05). Conclusion Neuronal regeneration exists in the dentate gyrus of hippocampus of adult mice. Chronic stress can inhibit neuronal regeneration, and lidocaine can prevent this inhibition and may promote neuronal regeneration by affecting adrenal cortex function and brain-derived nerve growth factor.

Objective to observe the effect of ketamine on airway hyperresponsiveness and inflammation in asthma model rats. Methods 56 Brown Norway rats were randomly divided into negative control group (Group A), asthma model group (Group B), different concentrations of ketamine aerosol inhalation pretreatment group (Groups C, D and E) and different doses of ketamine intraperitoneal pretreatment group (Groups F and G). The sensitized rats were injected with egg protein (OVA) supplemented with pertussis vaccine and aluminum hydroxide as adjuvant. The aerosol inhalation of 10 mg/ml OVA was performed. The rats in the ketamine pretreatment group were injected with 12.5 mg/ml, 25 mg/ml or 50 mg/ml of ketamine aerosol inhalation or 50 μ G/kg and 100 μ G/kg of ketamine intraperitoneal injection before challenge. Group A was inhaled with phosphate buffer instead of OVA for aerosol inhalation. 24 h after the last challenge, the airway responsiveness was measured. The expression of inducible nitric oxide synthase (iNOS) gene and protein, nitric oxide (NO) production and pathological histology were detected in lung tissues. Results (1) Expiratory obstruction in group B Moreover, the values of PC100, PC200 and PC400 were significantly lower than those of group A (14.65±1.19 vs 32.28±1.43, 15.17±1.19 vs 38.91±1.39 and 16.28±1.18 vs 56.53±1.38, respectively) (P<0.01). The Re dose-response curve of ketamine pretreatment group shifted to the lower right, while the values of PC100, PC200 and PC400 were significantly higher than those of group B (P<0.05). (2) Obvious inflammatory pathological changes were observed in group B. The degree of inflammatory cell infiltration and epithelial cell damage was significantly reduced in group B, and pulmonary interstitial edema was improved in group B (1.00±0.07 vs 0.48±0.07, P<0.01). Compared with group B, the expression of iNOS gene was significantly higher in group C (0.65±0.07), group D (0.58±0.09), group E (0.56±1.00) and group F (0.66±0.06), and the differences were statistically significant The difference was statistically significant (P<0.05). Conclusion Ketamine significantly inhibited the high expression of iNOS induced by allergen, reduced the excessive production of NO, thus reduced the inflammatory injury, inhibited the airway hyperresponsiveness, and had a lung protective effect on asthma model rats.

Objective to investigate the clinical significance of blink reflex (BR) examination and its synergistic effect with auditory brainstem evoked potential (BAEP) and repeated electrical nerve stimulation (RNS). Methods The results of BR examination in 584 patients from 1993 to 2005 were retrospectively analyzed in the electromyography room of Peking Union Medical College Hospital. The preliminary diagnoses or symptoms before examination were as follows: 161 cases of hemifacial spasm, 120 cases of facial or upper limb numbness, 102 cases of Bell palsy, 31 cases of trigeminal neuralgia, 30 cases of ptosis or labor in opening eyes, 28 cases of multiple cranial nerve palsy and brainstem lesions, 19 cases of cerebrovascular disease, 16 cases of unilateral facial atrophy, 13 cases of Guillain-Barre syndrome, 12 cases of connective tissue disease, 12 cases of diabetic peripheral neuropathy, 11 cases of head trauma, 10 cases of confirmed or suspected multiple sclerosis, 9 cases of Meige syndrome, 5 cases of Parkinson's syndrome and 5 cases of motor neuron disease. Results 279 cases of 584 cases of BR examination were abnormal, and the total abnormal rate was 47.77%. The abnormal changes of BR in peripheral damage of trigeminal nerve and facial nerve and brainstem lesions caused by various causes and the synergistic effects with BAEP and RNS were summarized. It has high diagnostic value for central brainstem damage; The synergistic application of BR and BAEP can improve the early detection and localization of brainstem lesions caused by multiple sclerosis and systemic diseases. The synergistic application of BR and RNS or single fiber electromyography can improve the differential diagnosis rate of blepharospasm and myasthenia gravis.

Objective to investigate the clinical characteristics and prognosis of Chinese patients with amyopathic dermatomyositis (C-ADM). Methods the clinical data of 29 patients with C-ADM were summarized, including 6 males and 23 females, with an average onset age of (44±8) years. Skin biopsy was performed in 5 patients, and lung CT examination was performed in all patients. Results All patients showed skin changes characteristic of dermatomyositis, including 27 cases (91.3%) of Gottron rash, 22 cases (75.9%) of Xiangyang rash, 11 cases (37.9%) of neck V-area rash and 7 cases (24.1%) of shawl rash. Six cases (20.7%) of periungual erythema and telangiectasia, of which 4 patients had ulcerated skin lesions. Gottron rash was most common in elbow joint (86.2%), followed by proximal interphalangeal joint (58.6%), metacarpophalangeal joint (48.3%), knee joint (23.8%), hip joint (20.7%), shoulder joint (13.8%) and ankle joint (9.5%). The histopathological changes of 5 patients with skin biopsy were consistent with the skin lesion characteristics of dermatomyositis. 19 patients (65.5%) were complicated with pulmonary interstitial lesions, of which 5 patients died during follow-up. The main cause of death was the progression of pulmonary interstitial lesions to respiratory failure. Conclusion C-ADM mostly occurs in middle-aged women, and typical rash is the key for diagnosis.

Objective to investigate the relationship between the positive rate of human papillomavirus (HPV) infection and the localization of infected cells in inverted papilloma (NIP) of nasal cavity and paranasal sinus and the prognosis of tumor. Methods 67 cases of NIP were divided into non-recurrence group, recurrence group and carcinogenic group according to the follow-up situation. The infection rate of HPV generic type and 16/18 type was detected by in situ hybridization method, and the localization of positive cells in epithelial nests was analyzed. 10 cases of inflammatory polyps of nasal mucosa were used as control, and the results were statistically analyzed. Results The total HPV infection rate in NIP was higher than that in the inflammatory polyps group, and the HPV infection rate in the recurrence group and carcinogenic group was higher than that in the non-recurrence group. The carcinogenic group was mainly infected with high risk (16/18) HPV; Conclusion HPV infection is related to recurrence and carcinogenesis of NIP, and the reason may be that HPV infection is more extensive in recurrence and carcinogenesis cases, and high-risk HPV infection in carcinogenesis cases.

Objective to evaluate the therapeutic effect of navigation-assisted minimally invasive percutaneous pedicle internal fixation in thoracolumbar fractures. Methods 51 cases of thoracolumbar fractures, 21 cases in Sextant group and 30 cases in conventional operation group were retrospectively analyzed. The surgical incision, operation time, bleeding volume, postoperative activity time and digital analogue pain score (NAPS) were compared in the aspects of surgical incision, operation time, bleeding volume, postoperative activity time and digital analogue pain score (NAPS) in Sextant group. The surgical incision was (2.4±0.4) cm, the mean operation time was (2.1±0.4) h, the mean intraoperative bleeding volume was (114.0±67.4) ml, the mean postoperative activity time was (2.0±0.7) d, the preoperative NAPS score was (7.0±1.0) and the postoperative NAPS score was (3.0±0.7).

Objective to investigate the influence of unilateral facet joint process graded resection on the stability of lumbar vertebra by biomechanical experiments, and to evaluate the initial clinical results of unilateral facet joint process resection, lumbar intervertebral bone graft fusion and unilateral pedicle screw internal fixation under endoscope through clinical studies.Methods Five fresh adult cadaveric spines were selected to make five functional units of 14-15 vertebrae, to study the influence of graded facet joint process resection on the anterior flexion, posterior extension, lateral flexion and axial rotation range of lumbar vertebra. Unilateral facet resection, intervertebral discectomy, nerve root release and decompression, autologous cancellous bone intervertebral graft, single intervertebral cage oblique intervertebral implantation and unilateral pedicle screw internal fixation were performed under endoscope. Results Unilateral facet resection had no obvious effect on early lumbar flexion and posterior extension. When the extent of unilateral facet resection exceeded 1/2, it had obvious effect on lumbar scoliosis and axial rotation (all P<0.05). The efficacy of 23 patients in this group was evaluated according to VAS pain visual score, ODI dysfunction index and Nakai grade. According to Nakai grade, 15 cases (65.2%) were excellent, 6 cases (26.1%) were good, and 2 cases (8.7%) were acceptable. The excellent and good rate was 91.3%, and the bone grafting fusion rate was 95.6%. Conclusion When the extent of unilateral facet resection exceeded 1/2, the stability of lumbar spine was significantly affected.

Objective to investigate the characteristics and clinical significance of hematological abnormalities in patients with systemic lupus erythematosus (SLE). Methods 236 newly diagnosed inpatients with SLE, among them, those with hemoglobin ≤100 g/L were assigned to anemia group; They were divided into two groups according to the white blood cell count. WBC 1 group with white blood cell count<3.0×109/L and WBC 2 group with white blood cell count 3.0~3.9×109/L; The main causes of anemia were: chronic disease anemia (ACD) (82 cases), hemolytic anemia (HA) (18 cases), hematopoietic dysfunction (8 cases) with unknown cause (15 cases), peripheral blood leukopenia (73 cases) (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.2%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.9%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.1%), peripheral blood leukopenia (30.9%, peripheral blood leukopenia (30.1% (30.1%), peripheral blood leukopenia ( But it is a very important indication of SLE disease activity. White blood cell count<3.0×109/L and platelet decrease are also related to SLE activity. Abnormal bone marrow hematopoiesis in some patients is one of the causes of more serious hematological changes.

Objective to investigate the expression of receptor-bound tumor antigen (RCAS1), vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in early invasive cervical carcinoma and their relationship with invasion and metastasis of cervical carcinoma. Methods Immunohistochemical S-P method was used to detect the expression of RCAS1, VEGF and MMP-9 in 95 cases of early invasive cervical carcinoma (ICC), 82 cases of cervical intraepithelial neoplasia (CIN) and 24 cases of normal cervical epithelium (NCE), respectively. The positive expression rates of VEGF protein were 16.7%, 41.5% and 67.4%, respectively; The positive expression rate of MMP-9 protein was 18.2%, 53.7% and 78.9%, respectively, and the difference was statistically significant (P<0.01). The expression of RCAS1 in ICC was related to pelvic lymph node metastasis, vascular infiltration, interstitial infiltration and histological grade (P<0.01). However, it was not related to age, histological type and clinical stage (P>0.05); The positive expression of MMP-9 and VEGF in ICC was correlated with pelvic lymph node metastasis, vascular invasion, interstitial invasion and clinical stage (P<0.05), but not with age, histological grade and histological type (all P>0.05). The expression of RCAS1, VEGF and MMP-9 protein was positively correlated in cervical cancer tissues (all P<0.01). Conclusion the abnormal expression of RCAS1, VEGF and MMP-9 protein plays an important role in the deterioration, invasion and metastasis of cervical cancer.

Objective to investigate the clinical and prognostic factors of medulloblastoma. Methods to retrospectively analyze the effects of tumor site, tumor resection rate, brainstem invasion degree, radiotherapy, chemotherapy, shunt surgery, glial differentiation and other related factors on the prognosis of 73 patients with medulloblastoma confirmed by postoperative pathology. Among the 73 patients, 48 were males and 25 were females, with an average age of 13.6 years. 55 patients were followed up. Results Among the 55 patients followed up, 6 died after operation, and the mean survival time of the remaining 49 cases was 61 months. The 5-year survival rate was 43% in 8 cases, and the prognosis of patients undergoing whole brain-posterior cranial-spinal cord radiotherapy was better than that of patients undergoing whole brain-posterior cranial radiotherapy alone. Conclusion the prognosis of patients with medulloblastoma is still poor, and regular radiotherapy and chemotherapy after surgical resection are helpful to improve the prognosis.

Objective to establish an animal model of post-stroke depression (PSD) and evaluate the intervention effect of citalopram. Methods the focal cerebral ischemia model was established by middle cerebral artery occlusion, and the PSD rat model was established by chronic unforeseen mild stress combined with orphanage and intervention with citalopram. Results On the 19th day after CMS, the horizontal activity scores (P<0.001 compared with baseline, normal and stroke groups; P<0.01 compared with stress depression group) and vertical activity scores (P<0.001 compared with baseline, normal and stroke groups; P<0.05 compared with stress depression group) of model rats were significantly decreased. From 19 to 42 days, the horizontal scores (from 37.8±1.7 to 34.2±1.2) and vertical scores (from 9.7±0.8 to 7.8±0.8) of model rats showed a progressive downward trend with different degrees of horizontal scores (from 41.0±1.3 to 42.3±0.8) and vertical scores (from 11.2±0.4 to 11.7±0.8) of stress depression group It is an ideal model for studying PSD. Citalopram can improve the behavioral abnormalities of PSD rats.

Objective to investigate the role of cation-chloride transporters NKCC1 (inward Na +, K + -2Cl-coordinated transport) and KCC2 (outward K + -Cl-coordinated transport) mRNA in the mechanism of epilepsy caused by cortical developmental disorders. Methods Carmustine (BCNU) was intraperitoneally injected into SD rats at 17 d of gestation to make a model of cortical developmental disorders. Nissl staining was used to observe the pathological changes of P60-day pups; The expression of NKCC1 and KCC2 mRNA in the hippocampus of two groups of male pups was detected by reverse transcription-polymerase chain reaction (RT-PCR) on P60D. Results Nissl staining showed abnormal aggregation of ectopic cells in the hippocampus. The expression of NKCC1 mRNA in the hippocampus of the experimental group was significantly up-regulated (the ratio of NKCC1/actin was 0.70±0.13 in the experimental group and 0.48±0.09 in the control group, P<0.01), and the expression of KCC2 mRNA was significantly down-regulated (the ratio of KCC2/actin was 0.54±0.10 in the experimental group and 0.81±0.15 in the control group, P<0.01). Conclusion The combined effects of up-regulation of NKCC1 mRNA and down-regulation of KCC2 mRNA may be closely related to epilepsy caused by cortical development disorder.

A 29-year-old female was admitted to the hospital in April 2006 due to fever, low back pain and skin nodules. Four months ago, the patient developed intermittent fever (body temperature 39℃), chest tightness, shortness of breath and lumbar pain, without spitting, urgency and pain in urination.

Cerebral edema is the main cause of death in patients with cerebral hemorrhage. After cerebral hemorrhage, there is an area around the hematoma where tissue damage and edema formation are progressively aggravated [1]. The pathological changes of brain tissue in this area are reversible within a certain time. If the pathological development process can be clarified, it is very meaningful to formulate a reasonable and effective treatment plan within this time window.

steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also commonly known as Hashimoto's encephalopathy (HE), also known as corticosteroidresponsive encephalopathy associated with Hashimoto thyroiditis [1], refers to persistent or fluctuating neurological or neuropsychiatric symptoms associated with increased concentrations of anti-thyroid autoantibodies in the blood.