Objective To investigate the effect of morphine preconditioning on mitochondrial permeability transition pore (MPTP) and its protective mechanism after myocardial ischemia-reperfusion injury. Methods A rat model of ischemia-reperfusion injury was established. Forty rats were injected with 2-3[H] DOG and then divided into 4 groups randomly: a sham operation (S) group, an ischemia-reperfusion injury (IR) group, a morphine preconditioning (Mp+IR) group, and a cyclosporine A preconditioning (CsA+IR) group. We monitored the concentrations of serum creatine kinase-Mb (CK-Mb) and cardiac troponin I (cTnI), and measured myocardial mitochondrial 2-3[H] DOG, cytochrome c content, Ca2+ concentration ([Ca2+]m), the velocity of Ca2+ intake and reaction half time of mitochondrial permeability transition pore (MPTP t1/2) in the 4 groups. Results The concentrations of serum CK-Mb and cTnI decreased more in the Mp+IR group and the CsA+IR group than those of the IR group. The concentrations of 2-3[H]DOG and [Ca2+]m in the IR group were evidently higher but the level of cytochrome c was lower than those of the sham operation group. The concentrations of 2-3[H] DOG and [Ca2+]m in the Mp+IR group decreased whereas the concentration of cytochrome c increased compared with those in the IR group. Mitochondrial 2-3[H]DOG content was positively correlated with the concentration of calcium (r=0.797, P<0.01). The 2-3[H]DOG and [Ca2+]m content were negatively correlated with cytochrome c in the IR group (r=-0.805 and r=-0.648, respectively, P<0.01). MPTP t1/2 in the IR group was shortened evidently, and that in the Mp+IR and CsA+IR group was significantly lengthened. Conclusion Morphine preconditioning may have myocardial protective effect through unburdening the calcium overload and lengthening the MPTP t1/2.

Objective To compare HER-2 state in breast cancer tissue deteced by fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC) and analyze their correlation. Methods HER-2/neu protein expression and gene amplification were detected by FISH and IHC in 56 newly-diagnosed cases of female breast cancer from July 2008 to July 2009. Results Of the 56 patients, HER-2 protein expression (-), (+), (++), (+++) was 9 cases (16.1%), 29 cases (51.8%), 11 cases (19.6%) and 7cases (12.5%) respectively; 26 cases (46.4%) had HER-2 gene amplification while 30 cases (53.6%) didnt have. Type of HER-2 gene amplification was mainly HER-2(++) and HER-2(+++), and according gene amplification rate was 72 7% and 100%. HER-2 (+) gene amplification rate was 37.9 %(11cases) and no gene amplification was found in HER-2(-) tissue. The HER-2 positive rate using two methods had significant difference(χ2=19.778,P<0.01). HER-2(-) and HER-2(+++) had good consistency with the FISH results(Kappa=0.969),but HER-2(+) and HER-2(+ +) were poorly consistent with the FISH results(Kappa=0.271). Conclusions IHC is the preliminary screening method for detection of HER-2 expression. HER-2(-) and HER-2(+++) have good consistency with the gene amplification, and can guide clinical treatment. Some patients with HER-2(+) and HER-2(++) have HER-2 gene amplification. FISH is needed for targeted therapy.

Objective To evaluate the ultrasonic feature and clinical significance of persistent left superior vena cava(PLSVC)in fetal life.Methods Fetal echocardiography was performed in 3368 fetuses.Thirty-one fetuses of PLSVC were confirmed.Results The dilated coronary sinus was observed in 30 of 31 fetuses.Congenital heart defects were presented in 14 of these cases,and extracardiac anomalies were presented in 6 fetuses.Both congenital heart defects and extracardiac anomalies were observed in 4 fetuses.Conclusions PLSVC is always associated with congenital heart defects.The prognosis Of affected fetuses largely depends on whether or not the PLSVC is associated with a congenital heart defect.Prenatal diagnosis of PLSVC can help US plan perinatal counseling and ameliorate the postnatal course.

Objective To investigate the role of opioid receptors in the protective effects of isoflurane-induced delayed preconditioning against myocardial ischemia-reperfusion (I/R) injury in rabbits. Methods Forty male New Zealand white rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups ( n = 10 each) : group I sham operation (S); group II I/R; group Ⅲ isoflurane + I/R (Iso) and group IV Iso + naloxone + I/R (Nal). Myocardial I/R was induced by 40 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion. In group Ⅲ (Iso) 2% isoflurane in 100% O2 was inhaled for 2 h and I/R was produced 24 h later. In group IV (Nal) naloxone 6 mg/kg was given iv 10 min before 2 h of 2% isoflurane inhalation and I/R was produced 24 h later. At the end of 120 min reperfusion, infarct size (IS) and area at risk (AAR) were determined by Evan's blue and TTC staining. Myocardial ultrastructure was examined by electron microscopy. The phosphorylated p38MAPK protein expression in myocardium was determined by Western blot. Results The IS was significantly smaller in group Iso ( Ⅲ ) ( 19.7% ± 2.8%) than in I/R group ( II ) (37.8% ±1.7%) (P<0.05). The phosphorylated p38MAPK protein expression in myocardium was significantly lower in group Iso than in group I/R. Microscopic examination showed less myocardial damage in Iso group than in group I/R. The protective effects of delayed preconditioning by isoflurane was prevented by naloxone pretreatment. ConclusionOpioid receptors may be involved in the protective effects of delayed preconditioning by isoflurane against myocardial I/R injury.

Objective This study aims to investigate the clinical value of percutaneous vertebroplasty (PVP)combined with strontium-89 (89 Sr)on patients with spinal malignant tumor.Methods Seventy four patients who were diagnosed as spinal malig-nant tumor were divided into two groups randomly.37 patients of the control group were treated by PVP only,and 37 patients of joint group were treated by PVP and 89 Sr together.Then the clinical effect of the joint group and control group was compared after treatment.Results After treatment,the quality of life,ratio of pain relief,clinical effect and survival time in joint group were dis-tinctly better than control group (P <0.05).Conclusion PVP combined with 89 Sr can be an effective and safe treatment for pa-tients with spinal malignant tumor.

Objective To evaluate the efficacy of epidural dexmedetomidine (Dex) and sufentanil on ropivacaine epidu-ral anesthesia. Methods A total of 120 cases of ASA Ⅰ to Ⅱ patients used epidural anesthesia with ropivacaine for lower limb orthopedic surgery were randomly allocated into epidural anesthesia with ropivacaine+normal saline group, ropivacaine+sufentanil group, ropivacaine+dexmedetomidine group, the hemodynamic changes, sensory block onset time, the highest plane of sensory block, sensory block continuous time, completed motor block time before and after anesthe-sia drugs and occurrence of adverse reaction of nausea, itching, vomiting were observed. Results The sensory block on-set time, complete motor block time in the dexmedetomidine group were shorter than the other two groups, with signifi-cant difference (t=4.25, 4.59, 4.32, 3.82, 3.79, 4.23, P<0.05); The duration of sensory block was higher than that in the other two groups, with significant difference (t=6.24, 5.78, P<0.05); Hemodynamic changes and adverse reaction rate in each group had no significant difference (P>0.05). Conclusion Epidural DEX can enhance the epidu ral anesthesia effect of ropivacaine than sufentanil effectively, and it does not increase the incidence of adverse reaction.

OBJECTIVE: To evaluate the role of transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) in the pathogenesis of pulmonary artery hypertension, we observed the dynamic expression of TGF-β1 and CTGF in rats with high blood flow. METHODS: Fifty adult male SD rats were randomly divided into 5 groups: a sham group (group S) and groups with right pneumonectomy for 1, 2, 4 and 6 weeks (PE1, PE2, PE4 and PE6 group), 10 rats per group. The mean pulmonary arterial pressure (mPAP), vessel morphometry and right ventricle hypertrophy index (RVHI) were measured. TGF-β1 and CTGF protein expression in the lung tissues were determined with immunohistochemistry and Western blot. The expression of TGF-β1 mRNA and CTGF mRNA in the lung tissues was evaluated by RT-PCR. RESULTS: Compared with group S, the mPAP and RVHI in the rats were significantly increased in group PE1, PE2, PE4, and PE6 (P<0.05); the indicators of vascular remodeling [(MA+PMA)%, RMT, and RMA] were markedly elevated in group PE4 and PE6 (P<0.05), but not in group PE1 and PE2. Immunohistochemical staining of TGF-β1 and CTGF were more prominent in all of the right pneumonectomy groups than in the sham group. Western blot showed that the level of TGF-β1 protein was significantly increased in all of the right pneumonectomy groups (P<0.01), and the peak was observed in group PE2, whereas the level of CTGF protein was markedly elevated in group PE4 and PE6 (P<0.05), but no change was noticed in group PE1 and PE2. Compare to group S, the mRNA level of TGF-β1 was dramatically increased in all right pneumonectomy groups (P<0.01), peaked at group PE2, and remained high in group PE4 and PE6. In contrast, the elevation of mRNA level of CTGF was not significant in group PE1, but group PE2, PE4 and PE6 demonstrated significant mRNA level of CTGF (P<0.01). Correlation analysis showed that the protein and mRNA levels of CTGF were positively correlated with RMT and RMA ( r=0.743, r=0.906; P<0.05), while no correlation between the protein and mRNA level of TGF-β1 with RMT or RMA. There was no correlation between the mRNA level of TGF-β1 and CTGF. CONCLUSION TGF-β1 and CTGF play a role in the pathogenesis of increased pulmonary blood flow-induced pulmonary hypertension.
Animals ; Connective Tissue Growth Factor ; metabolism ; Hypertension, Pulmonary ; metabolism ; Lung ; metabolism ; Male ; Pulmonary Artery ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism

Objective:To investigate the clinical characteristics and perinatal outcomes of pregnancy with placental cystic lesions.Methods:A retrospective study was carried out on 48 pregnant women diagnosed as pregnancy complicated with placental cystic lesions from January 2000 to January 2020 at the Women′s Hospital, Zhejiang University School of Medicine. The clinical features, pathological diagnosis and perinatal outcome were analyzed.Results:The age of 48 cases was (30±5) years, and the diagnostic gestational week of ultrasound was (24±8) weeks. Twenty-five cases in which showed a cystic mass at the fetal surface were diagnosed as placental cyst. The live birth rate was 100% (25/25) and the premature birth rate was 20% (5/25). Twenty-three cases showed “honeycomb like” cystic echo. Cystic lesions of 10 cases were located in the uterine cavity connected with the margin of the normal placenta, and finally diagnosed as hydatidiform mole and coexisting fetus (HMCF). Six cases of HMCF terminated pregnancy, and the live birth rate was 4/10, the premature delivery rate was 2/4. Cystic lesions of 13 cases were located in the placenta substance, and finally diagnosed as 4 cases of placental mesenchymal dysplasia (PMD) and 9 cases of focal chorionic edema; the live birth rate was 6/13 and the premature delivery rate was 4/6. The median hCG was lower in focal chorionic edema group [80 kU/L (60-110 kU/L)] than in the groups of HMCF [240 kU/L (180-430 kU/L)] and PMD [360 kU/L (210-700 kU/L)], and the differences were statistically significant (all P<0.01). Conclusions:For pregnancy complicated with placental cystic lesions, prenatal ultrasound should be performed to evaluate the shape, location and blood flow of the lesions. Maternal serological examination and invasive prenatal diagnosis are helpful for prenatal diagnosis and treatment. Due to the difference of perinatal outcomes, maternal and fetal complications, individualized pregnancy management should be carried out.

Objective:To analysis the income and expenditure of HIV-positive pregnant women and the catastrophic health expenditure of their households in high AIDS endemic areas in Liangshan prefecture.Methods:From December 2018 to January 2019, a total of 250 pregnant women were recruited from 2 of 17 counties in Liangshan Prefecture, including 133 HIV-positive pregnant women and 117 HIV-negative pregnant women. The data, including basic information of pregnant women, basic information of the family, annual family income in 2017, annual family health expenditure in 2017, and maternal and child-related expenditure in 2017, were collected for analyzing the incidence of catastrophic health expenditure in the family.Results:The average annual income and average annual health expenditure of HIV-positive pregnant women households were 7 000 CNY and 2 000 CNY, while those of HIV-negative pregnant women households were 10 000 CNY and 3 000 CNY, respectively. Based on the criteria of 15%, 25% and 40%, the incidence of catastrophic health expenditure of HIV-positive pregnant households was 39.10%, 33.83% and 27.82%, with average differences of 34.84%, 31.17% and 26.65%, respectively, while that of HIV-negative pregnant women households was 38.46%, 33.33% and 23.93%, with average differences of 31.68%, 28.35% and 24.22%, respectively.Conclusion:The incidence of catastrophic health expenditure of pregnant households in high AIDS endemic areas in Liangshan prefecture is high. The incidence of HIV-positive families is slightly higher than that of HIV-negative families. We suggest that medical insurance compensation in Liangshan prefecture should be improved to reduce the impact of catastrophic health expenditure.

Objective To explore the construction and practice of an intelligent prevention and treatment system for venous thromboembolism(VTE)in grassroots hospitals.Methods Based on rel-evant guidelines and expert consensuses on VTE prevention and treatment,domestic and foreign litera-ture was reviewed.A research and development team composed of clinical experts in VTE prevention and treatment,medical and nursing quality management experts,and information engineers conducted investigations and research in surrounding grassroots hospitals.Through evidence-based research and surveys,the team identified relevant business needs,user needs,and functional requirements of grass-roots hospitals,and finally formulated a detailed design plan.The main program of system was written in Java.The interface obtained data from the hospital's data platform through Webservice and view in-terfaces.To prevent issues of repeated data extraction when multiple applications perform time tasks to assess the same patient during later server usage and expansion,the XXL-JOB distributed task schedu-ling platform was adopted to handle VTE assessments by medical staff.Results After the clinical ap-plication of the intelligent VTE prevention and treatment system,the bleeding risk assessment rate in-creased from 26.20％at the initial system launch in January 2023 to 83.04％by the end of 2023.In January 2023,the implementation rates of mechanical prevention,pharmacological prevention,and combined prevention for medium-to-high-risk VTE patients were 21.39％,16.39％,and 5.26％,re-spectively,which increased to 51.75％,25.50％,and 25.65％in December 2023.Conclusion The VTE prevention and treatment software system developed by grassroots hospitals can improve devel-opment efficiency,enhance the clinical practicality of the system,reduce the workload of medical staff,promote standardization and normalization in VTE prevention and treatment,strengthen closed-loop management of medical quality for VTE as a single disease,and effectively improve the preven-tion and treatment capabilities and levels of VTE within hospitals.