1.Effects of exogenous phosphocreatine on brain energy metabolism of rats after cardiopulmonary resuscitation
Ting YANG ; Jianghua QIAO ; Dongfang LI ; Aiwen HE ; Shouquan CHEN ; Zhangping LI ; Huiping LI ; Weijia HUANG ; Junyan CHEHG
Chinese Journal of Emergency Medicine 2012;21(3):265-270
Objective To study the effects of exogenous phosphocreatine (CP) on brain injury after cardiopulmonary resuscitation (CPR) in rats.Methods A total of 160 male adult SD rats were randomly ( random number) divided into 4 groups:sham-operation control group ( group A),CPR group ( group B),low-dose CP group ( group C),high-dose CP group ( group D),and each group was further divided into 5 subgroups (n =8) as per study at different intervals,0.5,3,6,12 and 24 h after restoration of spontaneous circulation (ROSC) in groups B,C and D or after tracheotomy in group A.Cardiac arrest (CA) was induced by using asphyxia to establish CPR model in group B,C and D.The CP0.5 g/kg used in group C or CP 1.0 g/kg used in group D was injected into femoral vein at beginning of ROSC.Rats in each subgroup were sacrificed and the tissues of frontal lobe of brain of rats were taken at different intervals.The levels of adenosine triphosphate (ATP),adenosine diphosphate (ADP) and adenosine monophosphate (AMP) in cerebral cortex were measured by high performance liquid chromatography (HPLC),and values of total adenine nucleotides ( TAN ) and energy charge ( EC ) were detected.The activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase in cerebral cortex were assayed by spectrophotometric method. The pathological changes of cerebral cortex were observed under optical microscope.The experimental data were processed with analysis of variance by using SPSS 16.0 package. Results Compared with group A,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2+ -Mg2+ -ATPase were lower ( P < 0.05 or P < 0.01 ) at each interval in groups B and C,and at intervals of 0.5,3,6,12 h in group D,and the levels of AMP were higher (P < 0.01 ) at each interval in group B and at intervals of 0.5 h and 3 h in groups C and D.Compared with group B,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2 + -Mg2+ -ATPase were higher ( P < 0.05 or P < 0.01 ),and the levels of AMP were lower ( P < 0.05 or P < 0.01 ) at intervals of 6,12 and 24 h in groups C and D.Compared with group C,the levels of ATP at interval of 24 h and TAN,Na +- K + -ATPase,Ca2 + -Mg2 + -ATPase at intervals of 6,12 and 24 h were higher in group D ( P < 0.05 or P < 0.01 ).There were severe pathological changes in cerebral cortex in group B,and mild changes in groups C and D. Conclusions There was obvious energy metabolism disorder after CPR in rats.Treatment with exogenous CP could increase the levels of ATP and activities of ATPase,alleviate pathological changes,especially in high-dose,and mitigate injury in cerebral cortex after CPR in rats.
2.Effects of hemin on neuroglobin expression after cardiopulmonary resuscitation in rats
Aiwen HE ; Ting YANG ; Shouquan CHEN ; Zhangping LI ; Huiping LI ; Weijia HUANG ; Junyan CHENG ; Jie ZHANG ; Ping YAN ; Wantie WANG
Chinese Journal of Emergency Medicine 2010;19(12):1287-1290
Objective To study the effect of Hemin on the level of neuroglobin (NGB) in cerebral cortex,neurodeficit score (NDS) and pathological changes in cerebral cortex after cardiopulmonary resuscitation (CPR) in rats. Method A total of 120 male Sprague Dawley(SD) rats were divided randomly into control group(A), CPR group(B) and Hemin group(C). The animal model of cardiac arrest (CA) induced by asphyxia was established and CPR was performed. The NGB level in cerebral cortex, NDS and pathological changes in cerebral cortex were examined 0.5 h,3 h,6 h, 12 h, 24 h after restoration of spontaneous circulation (ROSC) in each group. Experimental data were analyzed by using one-factor analysis of variance and Tukey test. Results In comparison with group A, the levels of NGB were significantly higher 12 h,and 24 h after ROSC (P <0.05 and P <0.01), the values of NDS were significantly lower at each interval after ROSC ( P < 0.01 ) ,and the pathological changes were more severe at each interval after ROSC in group B. In comparison with group A, the levels of NGB were significantly higher 6 h, 12 h and 24 h after ROSC ( P < 0.05 and P < 0.01 ), and the values of NDS were significantly lower 3 h, 6 h, 12 h after ROSC ( P < 0.01) in group C. In comparison with group B, the levels of NGB were significantly higher 12 h and 24 h after ROSC, the values of NDS were significantly higher 12 h and 24 h after ROSC, and the pathological changes were less in group C. Conclusions The NGB level increased in cerebral cortex, the NDS level decreased and severe pathological changes occurred in rats after CPR. The hemin treatment up-regulated the level of NGB, improved the NDS, mitigated pathological changes, alleviating the cerebral injury after CPR.
3.Expression changes in apoptosis-related microRNA in cerebral cortex after cardiopulmonary resuscitation in rat models of cardiac arrest induced by asphyxia
Miaodan REN ; Aiwen HE ; Shouquan CHEN ; Zhangping LI ; Jianghua QIAO ; Dongfang LI ; Huiping LI ; Weijia HUANG ; Junyan CHENG
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2014;26(2):95-98
Objective To observe the expression changes in apoptosis-related microRNA(miRNA) in cerebral cortex after cardiac arrest-cardiopulmonary resuscitation(CA-CPR)in rats and explore the factors that may affect the mechanism of CPR. Methods 24 clean male Sprague-Dawley(SD)rats were randomly divided into three groups,the normal control group,sham operation group and CA-CPR group(each n=8). The animal model of CA induced by asphyxia was established and CPR was performed. In the normal control group,no special management was performed. In the sham operation group,only abdominal cavity anesthesia,tracheotomy,vascular puncture and electrocardiogram(ECG)were performed without clamping the trachea and resuscitating. Normal feeding in normal control group and 24 hours after tracheotomy in sham operation group,at 24 hours after recovery of spontaneous circulation(ROSC)in CA-CPR group,cerebral cortex specimens were obtained for detection of the expression of miRNA by using real time fluorescence quantitative reverse transcription - polymerase chain reaction(RT-PCR). Flow cytometry(FCM)was used to detect the neurocyte apoptotic rate. Results Compared between normal control and sham operation groups,there were no significant differences in the expression of apoptosis-related miRNA and neurocyte apoptosis rate of cerebral cortex(both P>0.05). Compared with sham operation group,in CA-CPR group, 16 miRNA expressions were up-regulated,including Let-7c,miR-15a,miR-21,miR-24,miR-29,miR-29b, miR-34a, miR-103, miR-200a, miR-200b, miR-200c, miR-210, miR-326, miR-338-3p, miR-494 and miR-497,and there were 22 down-regulated,being Let-7a,Let-7b,Let-7d,Let-7e,miR-19a,miR-19b-1, miR-20a,miR-20b,miR-23a,miR-23b,miR-25,miR-98,miR-107,miR-122a,miR-125a,miR-125b, miR-145,miR-181a,miR-181c,miR-335,miR-384-5p and miR-422a. Eight miRNA had significant changes at 24 hours after ROSC,in which miR-15a,miR-21,miR-34a,miR-497 were up-regulated respectively for 6.831±2.625,8.122±3.442,5.349±2.010,6.590±3.689 times,and miR-125b,miR-145,Let-7a,Let-7e were down-regulated respectively for 0.122±0.039,0.199±0.096,0.191±0.069,0.160±0.082 times. The apoptosis rate of cerebral cortex was increased significantly in CA-CPR group〔(32.23±5.31)%〕compared with that in normal control group〔(3.66±1.34)%〕and sham operation group〔(4.98±1.84)%,both P<0.01〕. Conclusions In early period after CA-CPR,obvious neurocyte apoptosis may be found in brain tissue of rats,and in the mean time, changes in apoptosis-related miRNA expression in cerebral cortex occur. The various types of miRNA with significant changes possibly play important roles in cerebral protection after CA-CPR in rats.
down-regulated respectively for 0.122±0.039,0.199±0.096,0.191±0.069,0.160±0.082 times. The apoptosis rate of cerebral cortex was increased significantly in CA-CPR group〔(32.23±5.31)%〕compared with that in normal control group〔(3.66±1.34)%〕and sham operation group〔(4.98±1.84)%,both P<0.01〕. Conclusions In early period after CA-CPR,obvious neurocyte apoptosis may be found in brain tissue of rats,and in the mean time, changes in apoptosis-related miRNA expression in cerebral cortex occur. The various types of miRNA with significant changes possibly play important roles in cerebral protection after CA-CPR in rats.
4.Postoperative rehabilitation strategy for acetabular fracture: application of 3D printing technique.
Aiwen DENG ; Ribo XIONG ; Weiming HE ; Dong WEI ; Canjun ZENG
Journal of Southern Medical University 2014;34(4):591-593
OBJECTIVETo explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture.
METHODSFor a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation.
RESULTSThe operation was completed successfully with a shortened postoperative recovery time.
CONCLUSIONSThe application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.
Adult ; Bone Screws ; Fracture Fixation, Internal ; methods ; Hip Fractures ; rehabilitation ; Humans ; Imaging, Three-Dimensional ; Male ; Postoperative Period ; Printing, Three-Dimensional ; Rehabilitation ; instrumentation ; methods
5.Follow-up study of factors influencing prognosis of cardiac arrest patients after acute myocardial infarction
Yuanli LEI ; Wenxing SONG ; Jinmei LU ; Yijin HE ; Zhangping LI ; Jike XUE ; Aiwen HE ; Qianqian ZHANG ; Jincun SHI ; Yingru LU ; Shouquan CHEN
Chinese Journal of Emergency Medicine 2018;27(7):740-746
Objective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI),and after ROSC,the effects of various factors on midian survival time and on 2-year survival.Methods In a registry study from January 2005 to January 2015,all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled.The survivors were followed-up for 2 years.Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival.Multivariable logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis.Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC.Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival.Results A total of 254 cases with CA after AMI were enrolled,including 129 cases of ROSC and 71 cases of 2-year survival.Univariate analysis showed age ≥ 70 years,CA occurred during 22:00-8:00,the duration time ofCPR ≥ 15 min and adrenaline dosage > 5 mg were unfavorable predictors of ROSC;while,left ventricular ejection fraction (LVEF) ≥ 40% before CA,shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors.Besides,age ≥ 70 years,intubation during CPR,adrenaline dosage > 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival;While,male,normal daily activity before CA and PCI treatment were favorable predictors.Multivariable analysis showed age,the duration of CPR,adrenaline dosage,LVEF before CA,the rhythm during CPR and PCI therapy were independent predictors of ROSC.Age and PCI therapy were independent predictors of 2-year survival.Among patients,the survival time was affected by various factors after ROSC,and the factors with minimum 25% and small median value were associated with cardiac rupture,cancer,adrenaline dosage > 5 mg and cardiogenic shock.The factor with maximum 25% value was PCI treatment (216 days).Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test,P=0.007);while,PCI treatment was a favorable factor (Log-rank test,P<0.01).PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI,the number of infarctrelated artery and the difference in culprit lesion.Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival.PCI treatment was favorable to both ROSC and 2-year survival.
6.Prevention and treatment of complications of transanal total mesorectal excision
Chinese Journal of Digestive Surgery 2019;18(8):741-746
Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years.This procedure performs a "bottom-to-up" resection of the rectum and its surrounding mesenteries through the anus,which provides better view compared with laparoscopic or open total mesorectal excision.However,it is undeniable that as a new surgical procedure,transanal total mesorectal excision is also bound to have some complications of surgery.Therefore,how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future.This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision.
7.Liver histological changes in patients with hepatitis B e antigen-negative chronic hepatitis B virus infection with low hepatitis B virus load
Li XIAO ; Yang LI ; Xiuzhen YANG ; Aiwen GENG ; Yilin HE ; Maocong YE ; Hongtao XU ; Jianchun XIAN
Chinese Journal of Infectious Diseases 2018;36(11):648-653
Objective To determine the predictive factors for antiviral therapy in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection [HBeAg(-) CHBI] patients with HBV DNA<4.3 lg IU/mL.Methods A total of 179 HBeAg (-) CHBI patients were retrospective analyzed.Histology activity index (HAI) and fibrosis (S) were scored according to the Knodell HAI scoring system,and HAI>3 and/or S≥3 was adopted as indications for treatment.Univariate and multiple regression analysis were used to assess factors associated with treatment indications.Receiver operating curves (ROC) and area under curve (AUC) were used to determine the predictive value of relevant factors.Results There were 81 cases with HAI>3 (45.3%) and 72 with S≥3 (40.22%),and the proportion of patients with indications for treatment was 54.7 %.Multiple regression analysis showed that age,γ-glutamyl transpeptadase (γ-GT),platelet (PLT) and albumin (Alb) were the predictive factors for the severity of liver damage and indication for treatment (all P<0.05).The AUC for age,PLT,γ-GT and Alb were 0.655,0.657,0.726 and 0.65,respectively,and the corresponding Yoden index for age,PLT,γ-GT,and Alb were 0.297,0.426,0.03 and 0.012,respectively,the sensitivities of predicting HBeAg (-CHBI for treatment indications were 0.643,0.842,0.705 and 0.653,respectively.Conclusions This study shows that 54.7% of HBeAg(-)CHBI patients with HBV DNA<4.3 lg IU/ml have significant liver histological changes and require antiviral treatment.Older age,higher γ-GT,lower PLT and lower Alb levels are the predictive factors for treatment.
8.Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): Chinese subgroup analysis.
Jiafu JI ; Han LIANG ; Youqing ZHAN ; Yunpeng LIU ; Yulong HE ; Yingjiang YE ; Yihong SUN ; Changming HUANG ; Ming YAN ; Yingqiang SHI ; Aiwen WU
Chinese Journal of Gastrointestinal Surgery 2014;17(2):133-138
OBJECTIVETo evaluate the efficacy and safety profile of XELOX (capecitabine/oxaliplatin) in patients with locally advanced gastric cancer who underwent curative D2 resection in China.
METHODSThis is a subgroup analysis of Chinese patients in the capecitabine and oxaliplatin adjuvant study in stomach cancer (CLASSIC study), which was a randomised, open-label, multicentre, parallel-group, phase III( study in the Asia-Pacific region. A total of 100 gastric cancer patients who received curative D2 gastrectomy were enrolled in this study and were randomly assigned to either XELOX group (oral capecitabine combined with intravenous oxaliplatin chemotherapy) or the control group (surgery alone). This study aims to compare the 3-year disease-free between the two groups.
RESULTSSubgroup analysis showed that 3-year DFS rate were 78% and 56% in XELOX and control group, respectively. The risk of relapse in XELOX group was reduced by 59% (HR=0.41, 95%CI:0.20-0.85, P=0.013), compared with the control group. The 3-year overall survival rate were 78% and 66% in XELOX and control group, with no statistically significant difference (HR=0.55, 95%CI:0.26-1.16, P=0.110).
CONCLUSIONAdjuvant XELOX chemotherapy following D2 gastrectomy may improve the survival in patients with advanced gastric cancer in China.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Capecitabine ; Chemotherapy, Adjuvant ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Disease-Free Survival ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Gastrectomy ; Humans ; Neoplasm Recurrence, Local ; Organoplatinum Compounds ; administration & dosage ; Stomach Neoplasms ; drug therapy ; surgery ; Survival Rate
9.Attaching importance to diagnosis and treatment of peritoneal metastases from colorectal cancer
Chinese Journal of Digestive Surgery 2018;17(2):138-142
Peritoneal metastasis from colorectal cancer (CRC) are generally considered to be end-stage disease of CRC,which has greatly impacted the prognosis and quality of life of patients.In recent years,cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy following systemic control has gradually been accepted for the treatment of peritoneal metastasis from CRC.Unfortunately,it has not widely used in clinical practice for the reasons of instruments,experience,surgical complexity,postoperative complications and cost-effectiveness.There is still no sufficient importance attached to CRC with peritoneal metastasis.Researches on the mechanism and treatment of peritoneal metastasis should be encouraged.Screening of high risk patients for early intervention to reduce incidence of peritoneal metastasis,selecting effective regimens and exploring optimal model for patients with other distal metastasis to improve the outcome of patients may be of importance.
10. Short-term outcomes and prognosis of palliative surgery for malignant bowel obstruction caused by peritoneal metastasis of colorectal cancer
Pengju CHEN ; Lin WANG ; Nan CHEN ; Xinyou LU ; Huaisong WANG ; Xun HE ; Zhi WANG ; Aiwen WU
Chinese Journal of Gastrointestinal Surgery 2019;22(11):1051-1057
Objective:
To explore the short-term efficacy and prognosis of palliative surgical treatment for malignant bowel obstruction (MBO) caused by peritoneal metastasis of colorectal cancer (mCRC).
Methods:
A retrospective cohort study was conducted. The inclusion criteria for patients were as follows: (1) primary colorectal cancer; (2) massive peritoneal metastasis; (3)obstructive site located below Treitz ligament by imaging; (4) obstruction refractory to conservative treatment; (5) estimated rese survival time more than 2 months; (6) patients and their families had strong willingness for operation; (7) surgical treatment included stoma/bypass and debulking surgery. In accordance with the above criteria, clinicopathological data of 46 patients undergoing palliative surgery at Peking University Gastrointestinal Cancer Center, Unit III from January 2016 to October 2018 were retrospectively collected. Postoperative symptomatic relief rate, morbidity of complication within 30 days, complication classification (Clavien-Dindo classification), mortality and survival after operation were analyzed. Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors.
Results:
Among 46 patients, 30 were male and 16 were female with median age of 63 (19-87) years; 23 patients received stoma/bypass surgery (stoma/bypass group), and 23 cases received tumor debulking surgery (debulking group). The overall symptom relief rate was 76.1% (35/46), while symptom relief rate in the debulking group was 91.3% (21/23), which was significantly higher than 60.9% (14/23) in the stoma/bypass group (χ2=4.301,