Objective To investigate the protective effect of ischemic pre-conditioning(IPC) on the spinal cord injury associated with abdominal aortic cross-clamping. Methods Forty-eight New Zealand white rabbits were randomly divided into IPC group and ischemic group. The concentrations of endothelin-1(ET-1), prostacyclin(PGI_2) and thromboxane A_2(TXA_2) in spinal cord were measured at six different time intervals, before ischemic, 40 minutes after ischemic, 2 hours,8 hours,24 hours and 72 hours after reperfusion. Neurologic function and pathological changes were documented. Results In IPC group, ET-1 level, TXB_2 level and TXB_2/6-keto-PGF_ 1? ratio were significantly reduced, while 6-keto-PGF1? level was significantly increased compared with that of ischemic group (P

Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities.Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment.The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery,the anterior and posterior tibial arteries and their collateral vessels.The number and distribution of those collateral vessels were also observed.Results The popliteal artery,anterior and posterior tibial arteries were all occluded due to atherosclerosis.However,there were three types of those collateral arteries:① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion.② Obliteration was only observed at the initial segment,with no obstruction at the distal end but extenuated.③ The collateral arteries originated from the bole artery symmetrically,keeping communicative with each other through punctiform interspaces.The last two types were mainly distributed at the inferior segment of popliteal artery,the superior segment of anterior and posterior tibial arteries,forming vascular anastomosing network in the whole cnemis muscle group.Conclusion Un-obstructed collateral arteries in certain places can be still found,though atherosclerosis obliteration is formed in popliteal artery,anterior and posterior tibial arteries in lower extremities.Therefore,it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.

AIM: To summarize the effect of femoral popliteal arterial graft operation and the influence of construction of bypass circuit outflow tract.METHODS: A retrospective study was performed in 15 cases of femoral popliteal arterial bypass.RESULTS: A femoral popliteal embolism occurred in one patient undergoing simple femoral-popliteal arterial bypass in the early postoperative period and in 2 patients in the long-term followed up.However,the effects of constructing bypass circuit in the same time were very well,and only one patient had chill on the limbs.CONCLUSION: The operative results are better when the construction of bypass circuit is performed in the femoral-popliteal arterial graft operation,further more,a new method is provided for construction of distal end outflow tract.

Objective To investigate whether the presence of sepsis associated encephalopathy (SAE) would predict nosocomial coma (NC) and poor outcome in patients with supratentorial intracerebral hemorrhage (SICH). Methods A retrospective cohort study was conducted. The adult acute SICH patients with or without coma admitted to intensive care unit (ICU) of Shuyang People' Hospital Affiliated to Xuzhou Medical University from December 2012 to December 2015 were enrolled. Brain computed tomography (CT) scans were analyzed and the patients were divided into pre-hospital coma (PC) and NC groups. The clinical data and the incidence of SAE of patients in two groups were compared, and the 30-day prognosis was followed up. Univariate and Cox regression analyses were performed to analyze whether SAE would predict NC and poor outcome in patients with SICH. Results A total of 330 patients with acute SICH and coma were enrolled, excluding 60 cases of infratentorial cerebral hemorrhage, 3 cases of primary intraventricular hemorrhage, and 6 cases of unknown volume hematoma. Finally, 261 patients were included, with 111 patients of NC events, and 150 patients of PC events. 69 (62.2%) SAE in SICH with NC and 33 (22.2%) SAE in SICH with PC was diagnosed, and the incidence of SAE between two groups was statistically significant (P < 0.01). Compared with PC group, SICH patients in the NC group had lower incidence of hypertension (81.1% vs. 96.0%), longer time from onset to NC [days: 2.3 (23.9) vs. 0 (0.5)] and length of ICU stay [days: 5.0 (34.0) vs. 3.0 (12.0)], higher initial Glasgow coma score (GCS, 10.2±1.5 vs. 6.6±1.6) and sequential organ failure assessment (SOFA) score [4.0 (6.0) vs. 3.0 (3.0)], lower initial National Institutes of Health Stroke Scale (NIHSS) score (19.4±6.6 vs. 30.2±6.8), as well as more frequent sepsis (78.4% vs. 38.0%), vegetative state (24.3% vs. 14.0%), acute respiratory failure (24.3% vs. 10.0%), pneumonia (37.8% vs. 24.0%), septic shock (8.1% vs. 0), acute liver failure (5.4% vs. 0), hypernatremia (8.1% vs. 0), CT indicating that more frequent vasogenic edema (64.9% vs. 16.0%) and white matter lesion (13.5% vs. 2.0%), and less mannitol usage (94.6% vs. 100.0%), and less brain midline shift (32.4% vs. 68.0%) and hematoma enlargement (8.1% vs. 30.0%), less hematoma volume (mL: 28.0±18.8 vs. 38.3±24.4) in CT, and higher 30-day mortality (54.1% vs. 26.0%) with statistical differences (all P < 0.05). It was shown by Cox regression analyses that SAE [hazard ratio (HR) = 3.5, 95% confidence interval (95%CI) = 1.346-6.765, P = 0.000] and SOFA score (HR = 1.8, 95%CI = 1.073-1.756, P = 0.008) were independent risk factors of death of SICH patients with NC, and hematoma enlargement was independent risk factor of death of SICH patients with PC (HR = 3.0, 95%CI = 1.313-5.814, P = 0.000). Conclusion SAE is the independent factor of inducing NC event and poor prognosis in SICH patients.

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE).Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome (SIRS)positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU).Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure (100%),in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases (33.3%),the cerebral ischemic lesions in four cases(66.7%).The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score (GOS) at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.

Objective To study the ability of human embryonic stem cells to integrate into mouse liver and to repair chronic liver injury of the recipient.Methods On day 1,day-7 and day-15 after human embryonic stem cells were induced to differentiate into hepatocyte-like cells and were transplanted into mice with chronic liver failure,liver histopathology,liver function,liver tissue regeneration and mature hepatocytes of mice were tested respectively.Results Hepatic tissue pathology of mice significantly improved after transplantation and necrotic foci diminished,hemorrhage and congestion of hepatic cells relieved,and liver function improved.It was observed that human embryonic stem cells survived,proliferated,integrated with host liver,and differentiated into mature hepatocytes.Conclusions Human embryonic stem cells xenotransplanted into mice can participated liver tissue regeneration to some extent,and differentiated into functional liver cells.

Castleman Disease ; Heart Neoplasms ; Humans ; Myxoma ; Retroperitoneal Space

Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Female ; Humans ; Liver ; pathology ; Liver Diseases, Alcoholic ; blood ; diagnosis ; Male ; gamma-Glutamyltransferase ; blood

Objective To improve the understanding of pulmonary mucormycosis by analyzing the clinical manifestations,imaging features,diagnosis,treatment and prognosis of this disease.Methods The clinical data of eight patients diagnosed as pulmonary mucormycosis by histopathologic examination were retrospectively analyzed.Results Eight patients included six males and two females with age from 36 days to 66 years.Underlying conditions covered diabetes (n =4),renal transplantation (n =3),premature (n =1) and long-term corticosteroid treatment in two cases.Imaging manifestations revealed multiple irregular lumps or nodules in three cases,multiple cavities with thick wall in three cases,diffuse lung infiltrate in one case and lung opacities in one case.The diagnoses of seven patients were confirmed by percutaneous needle lung biopsy and the remaining one was diagnosed with fiberoptic bronchoscopy biopsy.Surgery combined with amphotericin B liposome(60 mg/d for three weeks)was applied to one patient who was cured with no recurrence after a 22 month follow-up.Three cases were given amphotericin B liposome (a newborn with 7mg/d for 62 days,the other two 60 mg/d for 31 days and 70 mg/d for 71 days respectively).All had achieved marked response with follow up from 8 to 29 months,but one patient relapsed and died of recurrent lung mucormycosis.The other three patients were treated with itraconazole 400-200 mg/d from 21 days to 1 year with duration of follow up from 1 month to 20 months.One patient was not evaluable due to missing.Two patients relapsed and one died.Conclusion Pulmonary mucormycosis is difficult to diagnose and treat with a high mortality.Percutaneous tranthoracic lung biopsy is a useful diagnostic method.Amphotericin B liposome or itraconazole may be active against mucus.Early control of causes is essential to improve the prognosis and reduce the recurrence in patients with pulmonary mucormycosis.