ObjectiveTo explore the protective effect of low-molecular-weight heparin calcium (LHC) combined with trimetazidine on intestinal smooth muscle of intestinal acute mesangial vein thrombosis (AMVT) in rats and it's mechanism of effect. MethodsA total of 120 SD male rats were randomly divided into three groups, with 40 rats in each group. LHC group: after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) per 12 h until 72 h after surgery. LHC+trimetazidine group (LHCT group): after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) and tail vein injection the trimetazidine (10 mg/kg) per 12 h until 72 h after surgery. Normal saline group (NS group): after the AMVT model established, rats were subcutaneous injection the NS (0.2 mL/100 g) per 12 h until 72 after surgery. The AMVT model were established by blocking superior mesenteric vein of 8 cm and the edge vein arch. Vena cava blood samples and intestinal segments were collected sequentially at 6 h, 12 h, 24 h, 48 h and 72 h afrer surgery. The levels of malondialdehyde (MDA) and creatine kinase (CK) in the blood, and the level of ATP in the intestinal tissue samples were measured with ELISA. Intestinal tissue were taken from the rats for inestinal tissue section, stained with hematoxylin and eosin, examined under light microscopy and evaluated histopathologically using mesemeche scoring system at different time. ResultsCompared with the LHC group and NS group, the levels of MDA and CK in blood and histopathology score of intestinal tissues in rats were significantly decreased, and the level of ATP significantly increased in LHCT group at different time point (P < 0.05). ConclusionTrimetazidine can improve intestinal smooth muscle energy metabolism in the AMVT disease, comined with LHC early can avoid intestinal smooth muscle wall permeability coagulation necrosis and reduce the intestinal smooth muscle damage.
ObjectiveTo summarize the clinical characteristics and treatment of acute cellulitis of shank after total knee arthroplasty. MethodsWe retrospectively analyzed the clinical data of five patients with delayed acute cellulitis of shank after total knee arthroplasty treated in our hospital between January 2008 and January 2013. The clinical characteristics, treatment and prognosis of the disease were then summarized and analyzed. ResultsThe delayed acute cellulitis of shank after total knee arthroplasty was mainly caused by tinea pedis, which resulted in skin damage and bacteria diffusion. The main clinical manifestations were pain and swelling around the knee joint and shank. The laboratory test found the increasing of C-reactive protein, erythrocyte sedimentation rate, white blood cell and neutrophils. Two cases were caused by hemolytic streptococcus according to blood culture. All patients were discharged after treatment without periprosthetic infection. ConclusionAccording to the typical clinical manifestations and laboratory test, the diagnosis of delayed acute cellulitis of shank is not difficult. Timely and comprehensive treatment should be emphasized to seek and eradicate the primary lesions, such as tinea pedis, subcutaneous ulcer and carbuncle.
Objective To investigate the mechanism of gastrointestinal motility disorder of severe acute pancreatitis （SAP） in rats. Methods SD rats were randomly divided into 2 groups：sham operation （SO） group （n=16） and SAP group （n=16）. The gastric antrum interdigestive myoelectric complex （IMC） of rat was recorded by using bipolar silver electrode recording， the concentration of serum motilin （MTL） and vasoactive intestinal peptide （VIP） were detected by enzyme-linked immunosorbent assay （ELISA） method， and determined the pancreatic pathology score. Results Compared with SO group， the concentration of serum MTL obvious decreased and the concentration of VIP obvious rised in SAP group （P＜0.01）. Compared with SO group， the time of IMC cycle， andⅠand Ⅱ phase were extended， and time of Ⅲ phase was shortened， also the amplitude and frequency of peak electric of Ⅲ phase were declined in SAP group （P＜0.01）. And the concentration of MTL in SAP group showed positive correlation with the time of Ⅲ phase of IMC （r=0.967， P＜0.01）， the concentration of VIP in SAP group showed negative correlation with the time of Ⅲ phase of IMC （r=-0.592， P＜0.05）. The pancreatic organization pathological score in SAP group was higher than that in SO group （P＜0.01）. Conclusion There is gastrointestinal motility disorder in SAP rats， furthermore， it may induce gastrointestinal motility disorder through effecting the gastrointestinal smooth muscle electrical activity.
Objective To observe the expression of heat shock protein 70 (HSP70) in human liver after hepatic transplantation, and to study its correlation with the occurrence and progression of acute allograft rejection.Methods Fifteen biopsy specimen of allograft liver after transplantation were collected and divided into three groups according to their pathological changes: control group (no rejection), mild acute rejection group, and moderate/serious acute rejection group. The expressions of HSP70 in grafts were detected by using immunohistochemical method and imaging analysis. Results HSP70 was expressed in all 3 groups, and appeared mainly in hepatocellular cytoplasm. The immunohistochemical imaging analysis of HSP70 showed: integral optical density (IOD) which was 30.99±11.14 in the control group was lower than that in the mild acute rejection group (68.84±21.37) and that in the moderate/serious acute rejection group (71.82±19.99), P＜0.01； and the IOD in the moderate/serious acute rejection group was higher than that in the mild acute rejection group (P＜0.05). Conclusion HSP70 plays a role in cellular protection for allograft liver, and the continuously increasing expression of HSP70 in graft maybe closely relates to the occurrence and progression of acute allograft rejection.
摘要:目的：探討急性重癥胰腺炎（SAP）早期不同種類液體復蘇對其預后的影響。方法：應用隨機對照的方法,分別對2007年12月~2009年10月同期入院的48例SAP患者,隨機分成兩組,試驗組和對照組。試驗組第一周內液體復蘇采用晶體液和人工膠體（羥乙基淀粉）,對照組采用晶體液,其他治療方法不變。然后統計其第一周死亡率、ARDS、多器官功能障礙綜合征（MODS）發生率,對比兩組患者呼吸頻率、血氧飽和度和紅細胞壓積（HCT）差異,以及兩組患者腸功能恢復時間、住院時間以及并發癥發生率。結果：試驗組的液體復蘇較對照組顯著改善SAP的各項指標（P＜005）。血清乳酸水平（15±05）mmol/L,紅細胞壓積(HCT)為（324±69）%,ScvO2為（817±152）%,病死率83%,MODS發生率333%,〖HT5”H〗結論:〖HT5”SS〗 SAP早期聯合應用晶膠體進行液體復蘇可有效恢復循環血容量和防止體液潴留,顯著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.
目的 探討H2受體拮抗劑和質子泵抑制劑（PPI）緩解急性胃黏膜損傷的時效性研究。 方法 對2008年1月－2010年1月在急診科就診的98例急性乙醇中毒后胃黏膜損傷患者，隨機分為對照組50例，治療組48例。常規給予休息、保暖，補液，維持水、電解質、酸堿平衡，維持循環功能等治療基礎上，對照組給予H2受體拮抗劑治療，治療組給予PPI治療。通過觀察急性胃黏膜損傷患者上消化道癥狀及體征，記錄不同飲酒及飲酒量，并根據患者就診時間及不同飲酒組治療后上消化道癥狀完全緩解時間進行比較。 結果 治療組上消化道癥狀緩解所需時間與對照組比較差異有統計學意義（P＜0.001），不同飲酒組上消化道癥狀緩解時間上差異有統計學意義（P=0.000）。 結論 PPI在緩解急性乙醇中毒所致胃黏膜損傷的時效上更明顯，具有臨床價值。
ObjectiveTo investigate the prevalence and risk factors of deep venous thrombosis (DVT) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). MethodsOne hundred and eight patients with acute exacerbation of COPD admitted between March 2009 and September 2010 were consecutively included.On admission,color Doppler ultrasound examination of lower extremities was performed for diagnosing DVT in all cases.The patients with DVT were compared with those without DVT in demographics,symptoms,physical signs,risk factors and laboratory examination including Ⅷ factor and von Willebrand factor (VWF). ResultsAmong 108 patients with acute exacerbation of COPD,DVT was detected in 11 cases (10.1%).In the COPD patients with DVT,the duration of hospitalization was longer (P<0.001) and the mechanical ventilation requirement increased (P=0.024) compared those without DVT.Other indicators for more possibility of DVT were immobility over 3 days (P=0.001),pneumonia as concomitance (P=0.004),type Ⅱ respiratory failure (P=0.011),and current smoking (P=0.002).The plasma leukocytes,D-dimer and Ⅷ factor levels were significantly higher in the COPD patients with DVT than those without DVT (P=0.005;P<0.001;P=0.009). ConclusionThe incidence of DVT in patients with acute exacerbation of COPD is 10.1%.The prevalence of DVT is higher in distal extremities than that in proximal,especially the intermuscular veins.The patients with acute exacerbation of COPD have a higher risk of DVT when immobilized over 3 days,complicated by pneumonia or type Ⅱ respiratory failure,and having a high levels of plasma leukocytes,D-dimer and Ⅷ factor.