Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.
Acute respiratory distress syndrome following plastic operation of the abdominal wall with the purpose to reduce over-weight of the body in 3 case was reported. They all recovered following effective and appropriate treatment. The criteria for the diagnosis of ARDS were diseussed and the method of treatment was introduced and the importance of early diagnosis was emphasized.
Objective To investigate the effects of matrine on cell proliferation and expression of connective tissue growth factor( CTGF) and hypoxia inducible factor-1α( HIF-1α) of human lung fibroblast ( WRC-5) in normoxia ( 21% O2, 74% N2 , 5% CO2 ) and hypoxia ( 1% O2, 94% N2 , 5% CO2 )conditions. Methods MRC-5 cells were cultured and divided into differrent groups interfered with different dose of Matrine ( final concentration of 0 ～3. 2 mmol / L) in normoxia or hypoxia for 24 h. Cells were dividedinto 8 groups according to culture conditions, ie. normoxiagroup( N0 group) , normoxia + matrine 0. 2 mmol / L group( N0. 2 group) , normoxia + matrine 0. 4 mmol / L group( N0. 4 group) , normoxia + matrine 0. 8 mmol / L group( N0. 8 group) , hypoxia group( H0 group) , hypoxia + matrine 0. 2 mmol /L group( H0. 2 group) , hypoxia +matrine 0. 4 mmol /L group( H0. 4 group) , and hypoxia + matrine 0. 8 mmol / L group( H0. 8 group) . The MTT assay was used to measure the cell proliferation activity. Western-blot assay was used to examine the expression of CTGF and HIF-1α. Results Hypoxia promoted the cell proliferation in all groups( P lt;0. 05) .Matrine inhibited the proliferation of WRC-5 cells in a concentration-dependent manner in hypoxia or normoxia conditions( P lt;0. 05) . The expression of CTGF andHIF-1αwas lower in normoxia and higher in hypoxia( P lt;0. 01) . Matrine inhibited the expression of CTGF and HIF-1αin a concentration-dependent manner in hypoxiaand normoxia( P lt;0. 05) . Conclusion Matrine can inhibit the cell proliferation and the expression of CTGF and HIF-1αof WRC-5 cells in normoxia and hypoxia in a concentration-dependent manner.
ObjectiveTo investigate the effects of hypoxia inducible factor 1α (HIF-1α) overexpression on the differentiation of stem cells derived from human exfoliated deciduous teeth (SHED) into vascular endothelial cells.MethodsSHED was isolated from the retained primary teeth donated by healthy children by using collagenase digestion method. The third generation cells were identified by flow cytometry and alizarin red and alkaline phosphatase (ALP) staining after osteogenic differentiation culture. The SHED were divided into blank control group (SHED without any treatment), empty group (SHED infected with empty lentivirus), HIF-1α overexpression group (SHED infected with HIF-1α overexpression lentivirus), Wnt inhibitor group (SHED interfered by IWR-1), and combination group (HIF-1α overexpressed SHED interfered by IWR-1). Real-time fluorescence quantitative PCR (qRT-PCR) and Western blot were used to analyze the expressions of HIF-1α mRNA and protein in the SHED of blank control group, empty group, and HIF-1α overexpression group. Then the SHED in 5 groups were induced differentiation into vascular endothelial cells for 14 days. The expressions of cell surface marker molecule [von Willebrand factor (vWF) and CD31] were detected by flow cytometry. The mRNA expressions of vascular cell adhesion protein 1 (VCAM-1), KDR (Kinase-inserted domain containing receptor), and VE-cadherin (VE) were analyzed by qRT-PCR. The protein expressions of phosphate-glycogen synthasc kinase 3β (p-GSK3β) and β-catenin were analyzed by Western blot. The tube forming ability of induced cells was detected by Matrigel tube forming experiment. The ability of endothelial cells to phagocytic lipid after differentiation was detected by DiI-labeled acetylated low density lipoprotein (DiI-Ac-LDL) phagocytosis.ResultsAfter identification, the cells were SHED. After lentivirus transfection, compared with the blank control group and the empty group, the expressions of HIF-1α mRNA and protein in the HIF-1α overexpression group increased significantly (P<0.05). Compared with the blank control group and the empty group, the expressions of VCAM-1, KDR, and VE mRNA, the percentages of vWF positive cells and CD31 positive cells, and the relative expression of β-catenin protein were significantly higher (P<0.05), the relative expression of p-GSK3β protein was significantly lower (P<0.05), the number of tubules formed and the ability to phagocytic lipids significantly increased (P<0.05) in the HIF-1α overexpression group; while the indicators in the Wnt inhibitor group were opposite to those in the HIF-1α overexpression group (P<0.05). Compared with the HIF-1α overexpression group, the expressions of VCAM-1, KDR, and VE mRNA, the percentages of vWF positive cells and CD31 positive cells, and the relative expression of β-catenin protein were significantly lower (P<0.05), the relative expression of p-GSK3β protein was significantly higher, and the number of tubules formed and the ability of phagocytosis of lipids significantly reduced, showing significant differences between groups (P<0.05).ConclusionOverexpression of HIF-1α can promote SHED to differentiate into vascular endothelial cells by activating Wnt/β-catenin signaling pathway.
ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.
Objective To investigate the protection on the intrahepatic cholangiocyte mediated by hypoxic preconditioning (HP) after liver transplantation and the role of vascular endothelial growth factor (VEGF). Methods The model of autologous liver transplantation was established, and the rats were divided into 3 groups: autologous liver transplantation group, hypoxic preconditioning before operation group (HP group) and sham operation group. At 6, 12, 24, 48 h after operation, blood samples were collected for examination of the serum total bilirubin (TBIL), direct bilirubin (DBIL) and alkaline phosphatase (ALP), and the expression of VEGF was detected by immunohistochemical method. The pathological changes of cholangiocytes were observed by light microscope. Results As compared with autologous liver transplantation group, the levels of seurm TBIL, DBIL and ALP in HP group were lower (P＜0.05), while the expression of VEGF in HP group was higher at the whole process (P＜0.05). The degrees of billiary epithelium damage and inflammatory infiltration in autologous liver transplantation group were more severe than those in HP group. Conclusion HP has protective effect on cholangiocytes after liver transplantation, in which VEGF may play an important role.
ObjectiveTo investigate the expression of C/EBP homologous protein (CHOP) in lung tissue of chronic intermittent hypoxia rats, and explore the intervention effect of edaravone and its possible mechanism.MethodsA total of 120 adult male Wistar rats were randomly divided into three groups: a normal control group (UC group), a chronic intermittent hypoxia group (CIH group), an edaravone intervention group (NE group), and a normal saline group (NS group). The above four groups were also randomly divided into five time subgroups of 3 days, 7 days, 14 days, 21 days and 28 days, respectively, with 6 rats in each time subgroup. The histopathological changes of lung tissue were observed by hematoxylin-eosin (HE) staining and the expression of CHOP in lung tissue was detected by immunohistochemical method.ResultsHE staining results showed that there was no obvious pathological change in UC group. The epithelial cells of lung tissue in CIH group showed edema, hyperemia, widening of alveolar septum and inflammatory cell infiltration. The pathological injury was more serious with the prolongation of intermittent hypoxia time. There were also pathological changes in NE group, but the degree of lung tissue injury was significantly lower than that in CIH group. The results of immunohistochemistry showed that the expression of CHOP in CIH group was significantly higher than that in UC group. The expression of CHOP in NE group was higher than that in UC group, but it was still significantly lower than that in CIH group.ConclusionsThe expression of CHOP protein in lung tissue of chronic intermittent hypoxic rats is enhanced and the high expression of CHOP protein plays a certain role in the lung injury of chronic intermittent hypoxia rats complicated with lung injury. Edaravone may protect lung tissue from chronic intermittent hypoxia by inhibiting the expression of CHOP.
ObjectiveTo investigate the expression and significance of CD73 in rats with intermittent hypoxia and high fat diet.MethodsThe rat model of chronic intermittent hypoxia combined with high fat diet was established. Twenty-four healthy male Wistar rats in the SPF level were randomly divided into 4 group, with 6 rats in each group, namely group A (normoxia and normal diet), group B (normoxia and high fat diet), group C (intermittent hypoxia and normal diet)and group D (intermittent hypoxia and high-fat diet). After 6 weeks of experiment, the serum lipid levels, myocardial morphological changes under microscope, the expression level of CD73 protein detected byimmunohistochemistry and Western blot in myocardial cells in rats were compared among these groups.ResultsThe serum lipid levels were significantly different among these groups (P<0.05). HE results showed that the myocardial cells of group A had no obvious abnormalities; disorganized visible myocardial fibers with focal necrosis in groups B and C; myocardial cell injury was most obvious in group D, in which visible muscle fibers arranged in disorder, and grain was not clear, part of the muscle fibers were dissolved predominantly. Compared with group A, CD73 protein expression levels in myocardial cells in groups B, C, and D were significantly elevated (P<0.01). Furthermore, CD73 protein expression level in myocardial cells in group D was significantly higher than those in groups B and C (P<0.01). Western blot showed consistent results as immunohistochemistry: compared with group A, CD73 protein expression levels in groups B, C, and D were significantly elevated (P<0.05), and CD73 protein expression level in myocardial cells in group D was significantly higher than those in groups B and C (P<0.01).ConclusionChronic intermittent hypoxia and high fat diet can cause myocardial cell damage and upregulate CD73 expression in the cardiomyocytes.