As an important inflammatory cytokine, tumor necrosis factor-α (TNT-α) plays an important role in the process of cerebral ischemia-reperfusion. The discussion of the dynamic changes, the mechanism of neurotoxicity and antagonizing the therapeutic effect of TNF-α in the process of cerebral ischemia-reperfusion injury will provide theoretical basis for the treatment of cerebrovascular diseases.

Objective To observe the effect of strengthen rosuvastatin in the treatment of patients with paroxysmal atrial fibrillation in coronary artery disease and the influence on serum inflammatory factor, to provide reference for clinical treatment.Methods 176 coronary artery disease patients with paroxysmal atrial fibrillation were randomly divided into observation group and control group, 88 cases in each group.The control group was given rosuvastatin,10mg/d,qd.The observation group was given rosuvastatin,20mg/d,qd.The LAD and LVEF were detected by color-Doppler before treatment and after 6 months treatment.The fasting blood was exsanguinated for testing BNP,hs-CRP,TNF-α,IL-6.The incidence rates of sinus rhythm maintenance and embolic events were recorded. Results After treatment,the LAD of the observation group and control group were (41.50 ±4.61)mm and (42.21 ± 5.20)mm respectively,which were significantly lower than before treatment (t=3.959,3.863,all P<0.05),the LVEF were (76 ±6)% and (73 ±5)% respectively,which were significantly higher than before treatment (t =7.744,6.837,all P<0.01),there were no statistically significant differences between the two groups after treatment (t=1.140,0.579,all P>0.05).The BNP,hs-CRP,TNF-α,IL-6 levels of the observation group and control group after treatment were (173.44 ±32.45)ng/L and (203.33 ±42.16)ng/L,(4.54 ±1.34)mg/L and (5.44 ± 1.35)mg/L,(15.34 ±3.26) ng/L and (19.45 ±2.23) ng/L,(10.85 ±0.77) ng/L and (13.27 ±1.23) ng/L respectively,which were significantly lower than before treatment (t=5.855 and 3.533,3.857 and 3.534,6.436 and 4.545,5.743 and 3.925,all P<0.05),the BNP,hs-CRP,TNF-α,IL-6 levels of the observation group after treatment were significantly lower than the control group(t=3.546,3.214,3.176,3.414,all P<0.05).The total effective rate,sinus rhythm maintenance rate,embolic events incidence rate of the observation group and the control group were 93.18%(82/88) vs 79.55% (70/88),68.18% (60/88) vs 43.18% (38 /88),2.27%(2/88) vs 18.18%(16/88).The total effective rate,sinus rhythm maintenance rate of the observation group were significantly higher than the control group (χ2 =11.965,11.144,all P<0.01),the embolic event incidence rate was significantly lower than the control group (χ2 =12.129,P<0.01).Conclusion Strengthen rosuvastatin can effectively reduce the serum inflammatory factors and BNP,improve left atrial remodeling and left atrial function,the clinical efficacy and prognosis are significantly improved, it is worthy of clinical use in the treatment of patients with paroxysmal atrial fibrillation in coronary artery disease.

Objective To investigate the clinical pathological features of IgA nephropathy with nephrotic syndrome and risk factors for impairment of renal pathology.Methods 121 cases of IgA nephropathy with nephrotic syndrome were selected,all patients had been diagnosed with biopsy.The clinical pathological features wer analyzed, they were divided into two groups according to different kidney disease.The minor pathological changes which Leeˊs classification grade Ⅰ and grade Ⅱ patients belong to group A,with a total of 36 cases,while Leeˊs pathology heavier grade for grade Ⅲ,Ⅳ and Ⅴ grade level in patients belonging to group B,with a total of 85 cases.Clinical character-istics and clinical laboratory indicators of two groups were compared,and risk factors for renal pathological damage were analyzed in multivariate analysis.Results The average duration of group B was significantly longer than the average duration of group A,the difference was statistically significant (t =12.74,P <0.05).Mean arterial pressure of group B was significantly high than that of group A,the difference was statistically significant (t =5.31,P <0.05).Patients with hypertension,urinary erythrocytes with full vision and renal failureof group B were significantly more than those in group A,the differences were statistically significant (χ2 =14.29,9.74,8.26,all P <0.05).Total cholesterol and 24 h urinary protein excretion of group B were significantly lower than those in group A,the differences were statistically significant (t1 =8.75,t2 =6.73,all P <0.05).Serum albumin and hemoglobin levels of group B were significantly higher in group A,the differences were statistically significant (t3 =7.42,t4 =9.15,all P <0.05). Multivariate Logistic regression analysis showed,in IgA nephropathy with nephrotic syndrome,hemoglobin was a protective factor,the mean arterial pressure,24h urinary protein of red blood cells and microscopic urine >5.0 ×107 /Lwere dangerous aggravating factors.Conclusion Hemoglobin protective factors for IgA nephropathy with nephrotic syndrome,the mean arterial pressure,24h urinary protein excretion and urine red blood cells are their risk aggravating factors,they can make a more accurate judgment of the patientˊs condition.

ObjectiveTo study the efficacy of transcatheter arterial chemoembolization (TACE) combined with surgical resection in the treatment of ruptured hepatocellular carcinoma (HCC).MethodsThe clinical data of 26 patients who presented with ruptured HCC to our hospital from January 2008 to December 2011 were retrospectively studied. These patients received TACE (n=19),surgical resection (n=7),and surgical resection after TACE (n=8).ResultsShock in the 19 patients who received TACE was promptly corrected and the vital signs were stabilized.On subsequent CT,the tumors shrunk in size.Salvage liver resection was carried out in 8 patients 1 month after TACE.After treatment,AFP decreased or became normalized,thus the treatment results were good. A one-stage liver resection was carried out in 7 patients. One patient died after operation and peritoneal metastases occurred in 4 patients. Conclusions TACE stopped bleeding from ruptured HCC efficaciously,reduced the need for open exploration,and improved the rate of resection of HCC.TACE combined with surgical resection significantly lowered the rate of abdominal tumor metastases.

Objective To explore the role of remote ischemic preconditioning(RIPC)in prevention of contrast -induced nephropathy(CIN)in elderly patients undergoing coronary artery angiography(CAA).Methods 106 elderly patients were enrolled in this randomized control trial.According to random number table,the patients were randomized into control group (n =53)and RIPC group(n =53).All of the patients received 1 000mL of 0.9% sodium chloride injection before CAA.The RIPC group patients underwent RIPC in their right arms with sphygmomanometer cuff infla-tion for 5 minutes prior to the CAA,three cycles were repeated.Serum creatinine was detected before and 48 hours after CAA.Results CIN was reported in 10 cases in the control group and 3 cases in the RIPC group(χ2 =4.30, P =0.04).The levels of serum creatinine were increased[(96.38 ±9.50)μmol/L vs (88.87 ±10.24)μmol/L] after CAA in the control group(t =2.28,P =0.03),and there was no difference in the RIPC group(t =1.17,P =0.24).Conclusion RIPC has a protective effect on CIN in elderly patients in our study.Since this method is harm-less and cost effective,further studies is required to popularize PIPC to our clinical practice for prevention of CIN.

Objective To identify the types of pulmonary complications after pancreaticoduodenectomy,and to discuss the prevention and management of these complications.Methods Clinical data of 165 cases of pancreaticoduodenectomy in our hospital were retrospectively analyzed.Pulmonary complications were identified,therapeutic effects were observed.Results The incidence rate of pulmonary complications was 19.4％ ( 32/165),case-fatality rate was 6.25％ (2/32),two patients died from pneumonia,respiratory failure and ARDS.Complications mainly included pneumonia 13.9％ (23/165),pleural effusion 4.2％ (7/165),atelectasis 3.6％ (6/165),pneumothorax 1.8％ ( 3/165 ),respiratory failure 2.4％ (4/165) and ARDS 1.2％ (2/165).Conclusion Pulmonary complications after pancreaticoduodenectomy are not rare,especially for pulmonary infection and most are hospital acquired pneumonia.To understand rules and particularity of respiratory physiopathological changes after pancreaticoduodenectomy is very important for patients to safely pass over the perioperative period.

Objective To evaluate the efficacy of preoperative regional intra-arterial chemotherapy (RIAC) in the treatment of resectable pancreatic head carcinoma. Methods The clinical data of 50 patients with resectable pancreatic head carcinoma who had been admitted to the Research Institute of Pancreatic Diseases of Fudan University from December 2006 to July 2007 were retrospectively analyzed. Patients were randomly divided into2 groups (n =25 in each group): patients in group A were treated with preoperative RIAC followed by regional pancreaticoduodenectomy, and patients in group B were treated with surgical procedure routinely. The lymphatic metastases in the 50 specimens of pancreatic head carcinoma were detected by histological examination with hematoxylin and eosin (HE) staining, and lymphatic micrometastases were detected by immunohistochemical method with staining of cytokeratin AE1/AE3 in 10 specimens with negative HE staining of the lymph nodes in each group. Results There was no significant difference in the incidence of complications, the length of hospital stay and the 1-, 2-year survival rates between the 2 groups (χ2 = 0.12, 2.88, P > 0.05). The incidence of positive lymph node metastasis in group A was 7.1% (52/734), which was significantly higher than 22.1% (118/532) in group B (χ2 = 60.01, P < 0.05). The incidence of lymphatic micrometastasis was 9.4% (30/319) in group A, and 9.1% (23/252) in group B, with no statistical difference between the 2 groups (χ2= 0.01, P > 0.05). Conclusions Preoperative RIAC is helpful in improving the prognosis of patients with resectable pancreatic head carcinoma by reducing the incidence of lymphatic metastasis and decreasing tumor stage.

Animals ; Insecticides ; toxicity ; Nitric Oxide ; blood ; Organophosphorus Compounds ; Rabbits ; Superoxide Dismutase ; blood ; Vitamin E ; blood

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of pancreatic gastrointestinal stromal tumor (GIST). Methods We reported a case and reviewed the medical literature on pancreatic malignant GIST. We searched the Pubmed and main domestic database. The clinical data of the reported cases were studied, and their predictive factors for postoperative recurrence and metastasis were analyzed. Results Between January 1980 and July 2010, 16 cases of pancreatic GIST were reported. There were 7 males and 9 females, with a median age pf 56.5 (31-72)years. The clinical symptoms were nonspecific. The main presentation was upper abdominal pain or discomfort. A preoperative diagnosis was suspected on radiological examination. The tumor mainly appeared as a well-defined solid-cystic mass. Irregular enhancement appeared in the circumferential and solid portion of the tumor on enhanced CT scan sequences. The pancreatic and biliary ducts were rarely dilated. Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNA) was helpful in preoperative diagnosis. Of the 15 surgical patients, 14 underwent complete resection, while the remaining received cyst-jejunostomy. A correct diagnosis was made on histopathology and immunohisto-chemistry. On a mean follow up of 21 months (range, 1-60) in 14 patients, all patients were alive.Recurrence or metastasis occurred in 4 patients with tumors of high malignant potential. On univariate analysis, the only significant predictor for adverse outcome was mitoses≥10/50 HPF. Conclusions Pancreatic GIST is a rare tumor of relatively low malignant potential. It has a better prognosis than ductal adenocarcinoma. It is important to arrive at a correct diagnosis and treat the tumor with radical resection. Aggressive surgical resection is potentially curative. Imatinib is recommended in the treatment of patients with tumors with high malignant potential.

Objective To study the effect of minimal enteral feeding and mechanic ventilation on motilin(MTL) in premature infants and find a new way to promote gastrointestinal motility especially in critical illness,so as to develop their nutritional condition.Methods From Nov.2004 to Jun.2006, 60 premature infants were recruited at NICU of Xi′an children′s hospital,who were assigned to minimal enteral feeding and normal feeding groups,mechanic ventilationor non-mechanic ventilation was conducted based on premature infants′ illness.Their peripheral vein blood was collected at different time respectively: before their first breast-feeding,3 and 7 days after their birth and their MTL levels was measured by radioimmunoassay.The effect of 2 factors on hormones were factorially analyzed.The difference of gastrointestinal motility between 2 feeding groups.Results Mechanic ventilation could not alter MTL levels.But minimal feeding could significantly promote motilin′s secretion(P0.05).None of patients suffered from necrotizing enterocolitis.Conclusion Minimal enteral feeding can significantly increase gastrointestinal motility of premature infants,as well as those infants who are conducted mechanic ventilation.