Objective To investigate the relationship between preoperative albumin level and postoperative acute kidney injury(AKI)following off-pump coronary artery bypass(OPCAB)surgery;to confirm albumin cut-off value associated with AKI. Method This was a retrospective cohort study. data from patients who accepted OPCAB surgery in last two years in our hospital and AKI was diagnosed according to KIDGO-AKI criteria. Results Generalized additive model and multivariable logistic regression analysis have shown that the higher preoperative albumin level is related with the lower the incidence of AKI after OPCAB surgery. By generalized additive model,multivariable logistic regression analysis and ROC curve,we confirmed the albumin cut-off value associated with AKI between 39~40 g/L. Conclusion For patients undergoing OPCAB surgery,the higher preoperative albumin level ,the lower the incidence of AKI. In order to reduce the incidence of AKI in OPCAB surgery patients,preoperative albumin level higher than 40 g/L should be maintained.

10.3969/j.issn.1008-9691.2013.03.003

Objective To investigate the clinical characteristics of aerophagia in children,and to evaluate the effect of 24 hours esophageal multichannel intraluminal impedance monitoring in diagnosis of aerophagia.Methods The clinical data of 30 children with aerophagia hospitalized in Department of Digestive Disease,Nanjing Children's Hospital Affiliated to Nanjing Medical University from July 2005 to June 2013 were reviewed.The 24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases of aerophagia.The treatment of these patients normally included psychological counseling,dietary adjustment,Iactulose,Domperidone and vitamins,while Simethicone was given to the patients if normal treatment was invalid.Results Of the 30 patients,aged 2 to 13 years,averaged (8.6 ± 4.5) years,the chief complaints were abdominal distention in 30 cases (100.00％),visible or audible air swallowing in 28 cases (93.33％),repetitive belching in 27 cases (90.00％),reduced appetite in 25 cases (83.33％),constipation in 22 cases (73.33％),psychological stresses in 15 cases (50.00％),recurrent abdominal pain syndrome in 10 cases(33.33％),chronic diarrhea in 3 cases(10.00％) and acute abdominal pain in 3 cases(10.00％).Among the 30 patients,24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases,averaging 149.63 (47-553)times of air swallowing were recorded.In the 30 patients,24 cases (80.00％) were relieved after being treated with psychological counseling,dietary adjustment,lactulose,domperidone and vitamins,and only 6 cases(20.00％) were invalid for normal treatment but well responeded to Simethicone.Conclusions Aerophagia is a kind of functional gastrointestinal disorders in children.Abdominal distention,air swallowing,repetitive belching,reduced appetite,constipation and pain are common symptoms.It can be cured through psychological counseling management,diet modification,laxatives,propulsives and vitamins.24 hours esophageal multichannel intraluminal impedance monitoring is a useful technology in the diagnosis of aerophagia children.

Objective To evaluate the viability of residual tumor after insufficient thermal ablation of rabbit VX2 liver tumor and investigated the efficacy of sorafenib as an adjuvant therapy.Methods Twenty-one rabbits were implanted with VX2 tumor to establish orthotopic liver tumor models.They were allocated randomly into 3 groups:control (n =7),ablation (n =7),and combination treatment (n =7).Microwave coagulation therapy was conducted with 20 W for 1 min and viable tumor tissue remained at the periphery.A laparotomy was performed in the control group.Sorafenib was given at 20 mg/kg/d during the following 10 days in the combination treatment group,and saline was given to the control and ablation group.Tumor volume was recorded before and after treatment,immunohistochemistry detected CD31 and proliferating cell nuclear antigen (PCNA) expression,and the micro-vessel density (MVD) and proliferation index (PI) were calculated accordingly.Results Ten days after insufficient ablation,tumor volume of the ablation group was larger than that of the control group (P ＜0.05).The MVD and PI of residual tumor were higher compared with those of the control group (P ＜ 0.05).With adjuvant therapy of sorafenib after insufficient ablation,tumor volume showed a decrease on the 10th day compared with tumors undergoing insurfficient ablation alone (P ＜ 0.05).The MVD and PI of residual tumor were lower than those of the ablation group (P ＜0.05).Conclusion Insufficient thermal ablation promotes residual tumor progression,but adjuvant therapy of sorafenib serves as an effective way to suppress the overgrowth and neovasculation of the residual tumor.

Chaihu Injection (CI), which is widely used in treatment of febrile diseases, is an aqueous solution of Chaihu (Radix Bupleuri Chinensis) or Nanchaihu (Radix Bupleuri Scorzonerifolii) prepared by steam distillation.

Objective To study the effects of embryonic neural stem cells transplantion on trauma of red nucleus neu-rons of the rats with spinal cord injury.Methods NSCs in logarithmic phage were labeled with BrdU,a Sprague Dawley rat mode of spinal cord injury (SCI) was developed with electrocircuit control spinal cord injuring device.Thirty SD rats were randomly divided into three groups: sham group,SCI group and NSC group.The NSCs were trans-planted into injured site three days after SCI.Then NSCs labeled with Brdu were detected by immunohistochemisty,rubrospinal tract (RST) neurons were labeled by retrograde transport of the horseradish peroxidase (HRP) from the lesion site,which were taken by damaged axons and remained in the neurons,then the labeled red nucleus (RN) neurons were counted.Hind limb function of experimental rats was evaluated by a blinder observer using BBB open field locomotion rating score.Results BrdU positive NSCs were detected in the spinal cord after transplantation,the number of RST neurons labeled by HRP in NSC group was more than that in SCI group (P <0.01),the BBB score of NSC group was higher than SCI group (P <0.01).Conclusion The transplanted NSCs can survive in the injured site of spinal cord and protect RN,then promote more remarkably functional recovery after SCI.

Objective To prospectively study the main risk factors of variceal bleeding in cirrhotic patients. Methods Fifty-seven patients with liver cirrhosis and esophageal varices who had never experienced variceal bleeding were followed up for 12 months. The patients underwent measurements of esophageal variceal pressure by non-invasive endoscopic balloon technique. The endpoint of the study was the presence of a variceal hemorrhage. The relationship between variceal hemorrhage and endoscopic findings including varices, variceal pressure, Child-Pugh status, ascites, and etiology of cirrhosis was studied. Results Thirty-four patients (59.6% ) developed a variceal hemorrhage. In univariate analysis, the level of variceal pressure (P= 0. 001), the size of varices (P=0. 006), and the endoscopic red color sign on the variceal wall (P=0. 012) predicted higher risks of variceal hemorrhage. The multiple logistic regression revealed that variceal pressure was a major predictor of the risk for a first variceal bleeding (OR=2. 817, P=0. 003). The area under the receiver operating characteristic (ROC) of variceal pressure for predicting variceal bleeding was 0. 98, and the variceal pressure cutoff value was 25.3 mm Hg (1 mm Hg=0. 133 kPa) with both specificity and sensitivity of 91 %. Conclusion The level of variceal pressure is a major predictor for variceal bleeding in cirrhotic patients.

Objective: To investigate the effects of electro-acupuncture on obestatin in rat with simple obesity. Methods: Obesity was induced in male SD rats with high-fat and -glucose diet for 10 weeks. Twenty-four rats with obesity were randomly divided into untreated group and electro-acupuncture group, with 12 rats in each group. Another 12 normal SD rats serving as controls were fed standard rat chow. Rats in the electro-acupuncture group were treated with electro-acupuncture on bilateral Zusanli (ST36), Tianshu (ST25) and Pishu (BL20) acupoints for fifteen days consecutively. Rats in the blank control group and untreated group were not interfered. Body weight was measured every 3 days during treatment. After treatment, obestatin in serum and hypothalamus was detected by radioimmunoassay or immunohistochemiscal method respectively. Visceral fat weight was also detected. Results: Body weight and visceral fat weight of rats in the untreated group were significantly higher than those in the blank control group (P<0.01). Body weight and increase of body weight in the electro-acupuncture group were significantly lower than those in the untreated group (P<0.01). Visceral fat weight in the electro-acupuncture group was significantly lower than that in the untreated group (P<0.01), but there was no significant difference as compared with the blank control group. The obestatin expression in hypothalamus was higher in the untreated group than in the blank control group (P<0.05), while it was lower in the untreated group than in the electro-acupuncture group (P<0.01). Conclusion: Electro-acupuncture has an effect against obesity in rats, which may be related to up-regulating obestatin expression in hypothalamus.

Objective To evaluate the effect of fast track surgery on immunologic functions and clinical outcome in patients with gastric cancer during perioperative period. Methods Thirty-six gastric cancer patients receving radical operation were randomly divided into two groups: fast track group (18, fast track surgery) and conventional management group (18, non-fast track surgery). Serum levels of IgA、IgM、 IgG and C reaction protein (CRP) in 36 patients were assayed preoperatively and postoperatively on 1st, 3rd, 7th day. The postoperative hospital stay, duration of fever, inhospital expense, postoperative time of flatus and postoperative complications were recorded respectively. Results On the postoperative 3rd day, serum levels of IgA [(1.57 ± 0. 40) g/L vs. (1.27±0.49) g/L, P <0. 05],IgG[(9.99 ± 2. 12) g/L vs.(8.53±2. 15)g/L, P<0.05]and IgM [(0.92 ± 0.18) g/Lvs. (0.78 ± 0.20) g/L, P<0.05]in patients of fast track group were significantly higher than those in patients in non-fast track group. On the postoperative 1 st, 3rd , 7th day, serum levels of CRP [d1 (56 ± 10) g/L vs. (79 ± 9) g/L,P < 0. 05];d3[(140±15) g/L vs. (170±15) g/L, P<0.05)];d7 [(52±11) g/L vs. (78±12) g/L,P<0.05]in patients of fast track group were significantly lower than those in patients in non-fast track group. The duration of fever [(2. 4 ± 0.9) d vs. (3.8 ± 0. 8) d, P < 0.05], passage of gas by anus [(3. 1 ± 0. 8) d vs. (4.4±0.7) d,P<0.05], time of hospitai stay [(6.3 ± 1.2) d vs. (8.2 ± 0.9) d,P<0.05]and treatment expense in patients of fast track group[(25 260 ± 2910) $ vs. (30 651 ± 3578) $ ,P <0. 05]were also significantly lower than those in non-fast track group (P < 0. 05). Patients in fast track group had no more complications than those in non-fast track group (P > 0. 05). While discharged from hospital, the quality of life score [(14. 8 ± 1.9) vs. (16. 1 ± 1.6), P < 0. 05]in patients of fast track group was significantly higher than that in patients in non-fast track group (P < 0. 05). Conclusions Fast track surgery mitigates the immunologic impairment of gastric cancer patients during perioperative period, and accelerates postoperative rehabilitation.

OBJECTIVE:To establish a method of determining the plasma concentration of capecitabine/polyethylene glycol 1000/montmorillonite (CAP/PEG1000/MMT) in rats’plasma for the study on pharmacokinetics of CAP compound in rats in vivo. METHODS:HPLC was adopted. The determination was performed on Kromasil C18 with mobile phase consisted of 0.1% glacial acetic acid-acetonitrile(73∶27),at the flow rate of 1.0 ml/min. The detection wavelength was 250 nm and column temperature was 40 ℃. The sample size was 10 μl. 18 Wistar rats were randomly divided into CAP group,CAP/MMT group(MMT as carrier)and CAP/PEG1000/MMT group(PEG1000/MMT as carrier)and ig given corresponding drugs,that equal to 200 mg/kg of CAP. Blood sample was respectively taken 15,30,60,90,120,180,240,300 and 360 min after the administration of drugs,and plasma was isolated and added with internal standard ferulic acid. The concentration of the drug in the plasma was determined by HPLC fol-lowing protein precipitation with methanol,based on which the pharmacokinetic parameters were calculated by 3p97 software. RE-SULTS:The linear range of CAP was 0.054 9-4.390 0 μg/ml (r=0.998 2) with the method recovery of 98.2%-102.1%(RSD=1.50%-3.29%, n=5) and absolute recovery of 76.2%-78.9%(RSD=2.29%-2.99%, n=5). In the above-mentioned three groups,t1/2 were(1.11±0.32),(1.57±0.32)and(1.62±0.10)h;cmax were(2.91±0.36),(0.91±0.23)and(0.91±0.14)μg/ml;AUC0-6 h were (8.70 ± 1.79),(3.76 ± 0.27) and (3.73 ± 0.25)μg·h/ml;and tmax were (0.97 ± 0.20),(1.55 ± 0.47) and (1.50 ± 0.07) h,respectively. There was no significant difference in the pharmacokinetic parameters between the CAP/MMT group and CAP/PEG1000/MMT group(P>0.05). CONCLUSIONS:The method is reliable and simple,and can be used for pharmacokinetic study of CAP/PEG1000/MMT in rats. MMT and PEG1000/MMT compound can prolong CAP acting time in the body.