Objective Discussing the clinical features, early diagnosis and therapeutic methods of aortic dissection (AD). Methods We analyzed and concluded the clinical datum of 33 AD patients in our hospital. Results The rate of male to female was 5.6 to 1 among all patients, average age 60, hypertension accounted for 81.8 percent. There were 26 patients (78.8 percent) suffered an acute pain, of who 22 patients got a pain in anterior chest.There were 22 of 26 patients diagnosed AD through echocardiography, 20 and 11 patients confirmed AD by MRI or CT respectively among all 33 patients. 13 patients had abnormal ECG, 10 ST-T segment changed, 12 left ventricular hypertrophy or hyper-voltage. Hypertension patients were treated through a infusion of nitroglycerin or nitroprusside by intervenous drop or by vein pump firstly to decend systolic blood pressure to the level of 100~120 mmHg and heart rate to 60~70 bpm,combining with the use of beta blocker, calcium antagonist and rennin- angiotensin inhibitor. 27 patients’ pain alleviated gradually even disappeared after controling their blood pressure, whose state of illness became to stable. 2 persons did the operation of aortic replacement in emergency. 6 persons died for aortic dissection broken in one week or one month. Conclusions The clinical manifestations of AD are complex, and the rate of false or leak diagnosis is high. Radiology studies including echocardiography, MRI or CT may be very important to enhance the ability of diagnosing AD early and to guide the treatment. Taking medical treatment is primary in emergency. Operating the replacement of aorta is an effective measure to treat AD.

Objective To evaluate plasma BNP level change in acute pulmonary embolism and its clinical value.Methods 33 cases were diagnosed by CT pulmonary angiography or DSA.they were divided into two groups:the group with right ventricular(RV)dysfunction group and the group without right ventricular(RV)dysfunction.Plasma BNP was detected by Triage BNP test.otherwise,we observed severe clinical presentation、 death rate and mechanical ventilation in two groups.Results Plasma BNP level is higher in the group with RV dysfunction(288?102pg/ml)than that in the group without RV dysfunction(61?32pg/ml)(P

Objective To investigate the change and significance of electrocardiogram and myocardial damage index in patients with acute organophosphorus pesticide (AOPP).Methods 71 hospitalized patients in EICU with AOPP from January 2000 to June 2006 were recorded.The patients were divided into 3 groups: mild poisoning group (n=18),moderate poisoning group(n=22) and severe poisoning group (n=31).Electrocardiogram(ECG), serum creatine kinase(CK), serum creatine kinase isoenzyrne MB(CK-MB),lactate dehydrogenase(LDH) and TnI were detected,the relation between the above-mentioned indexes and the toxical degree were analyzed.Results Abnormal ECG had a rasied tendency along with increase of the poisoning degree.The incidence of Ⅱ~Ⅲ atrioventricular block, atrial premature beats, ventricular premature contraction, ventricular tachycardia and ventricular fibrillation in severe poisoning group significantly increased compared with that in mild poisoning group and moderate poisoning group(P

Objective To investigate methods of weaning acute brain stem hemorrage patients with respiratory failure from mechanical ventilation.Methods This was a retrospective analysis of 45 acute brain stem hemorrage patients with respiratory failure requiring mechanical ventilaiton.Results 15(33.3%)patients were successfully weaned from mechanical ventilation for the first time;the other 30(66.7%)patients failed in the first place,then succeeded after 3~7 days of and occasional disconnection from ventilation.The time of mechanical ventilation varied from 6 to 35 days.Conclusion It is difficult to wean acute brain stem hemorrage patients with respiratory failure from mechanical ventilation.Occasional disconnction from ventilaiton,antiinfection and nutritional supplementation might contribute to successful weanning.

Objective To study the effects of naloxone on ?-endorphin (?-EP) in plasma and on myocardial ultrastructure during myocardial ischemia-reperfusion (I/R) injury in rabbits.Methods The myocardial ischemia models and myocardial ischemia -reperfusion injury models in rabbits,by ligating the left anterior descending branch of coronary artery,were used to investigate the changes of ?-EP and ET-1 in plasma during I/R injury, and after treatment with naloxone, an antagonist of opiate receptor. 20 New Zealand rabbits were randomly assigned to 2 groups (each 10 rabbits in naloxone treatment and ischemia-reperfusion group). The bloods were taken at different times in each group. The concentrations of ?-EP and ET-1 were detected with radioimmunology method.The changes of myocardial ultrastructure in samples of myocardial ischemia,were observed through electron microscope.Rseults The levels of ?-EP were significantly improved after I/R injury compared with those before ischemia (P0.05). For ischemia-reperfusion group, most of cardiac muscles were in the contracting state, the myofibril dissolved and broke locally. The edema was found on the circumference of nucleus. For naloxone treatment group, the structure of myofibril was clear and its arrangement was in good order, and no obvious breakage was found. The contracting of myofibril, the edema of mitochondria and kytoplasm were moderating. Conclusion Naloxone may effectively control the levels of ?-EP and the synthesis and secreting of ET-1 after myocardial ischemia and during I/R injury;and reduce the injury to the myocardial ultrastructure and decrease the injury to blood vessel and myocardium.

Objective To explore effects of hcmoperfusion on toxic ingredients in plasma of rabbiis with a-cute intoxication of Radix Aconiti Kusmezoffii Monkshood.Method Sixteen male Japanese Giant Ear Rabbits were randomly divided into acute poisoning(AP)group and acute poisoning + hemoperfusion(AH)group(8 an-hnals in each group).Acute poisoning models were established in rabbits of both groups with intragastric adminis-tration of Radix Aconiti Kusmezoffii Monkshood liquid in dose of 1 mL/kg in order to produce arrhythm which oc-curred within ode hour after intragastric administration was regarded as the criteria of successful animal model.and then hemoperfusion with active carbon was performed for 2 hours in AH group.The pathological chanses of brain,myocardium and hepatic tissues were observed.The plasma concentrations of toxicants including mesaconitine,a-conitine and hypaconitine were measured by using HPLC-MS at 1 h,2 h,3 h,and 6 h after poisoning.Student's T test was used to identify the significance.Results The brain.myocardium and hepatic tissues of the rabbits in AP group showed hyperemia and edema which were attenuated after hemoperfusion.The plasma concentrations of mesaconitine,aconitine and hypaconitine revealed no significant differences between AP group and AH group with-in one hour after poisoning(P＞0.05),while at 2 h and 3 h after poisoning,the plasma concentrations of mesaconitine were(2.11±1.08)ng/mL,(2.02±1.46)ng/mL,respectively,aconitine(39.70±9.31)ng/mL,(19.71±16.06)ng/mL,respectively,and hypaconitine(1.70±0.71)ng/mL,(2.12±1.33)ng/mL,respec-fively in AH group,and they were significantly lower than those in AP group(P＜0.05).Conclusions The the plasma concentrations of mesaconitine,aconitine and hypaconitine were lower and the histopathological changes were attenuated after hemoperfusion.Hemoperfusion is a good intervention for acute intoxication of Radix Aconiti Kusmezoffii Monkshood.

Objective To investigate clinical features,treatments and prognostic factors of the patients with necrotizing fasciitis caused by vibrio infections and thus provide reference for the early treatment and prognostic assessment.Methods A retrospective analysis was conducted on clinical data of 56 patients with vibrio necrotizing fasciitis admitted to the emergency center of our hospital from May 1995 to June 2011.The clinical characteristics and treatments of the patients were summarized,and differences of clinical factors between the survival group and death group were compared.The possible influencing factors for prognosis were also analyzed.Results The main clinical manifestations included fever (61％),shock (84％) and organ dysfunction,of which renal insufficiency (88％) was the most common,with case fatality of 43％.Early pathological changes of limbs were only local swelling and pain,while skin ecchymosis,tension blood blisters,necrosis and subcutaneous crepitation were the signs of advanced stage.Comprehensive treatment regime including early administration of sensitive antibiotics plus surgical incision and drainage and medicine support was given.A series of factors were significantly different between the survival and death groups including the duration from the presentation of symptoms to hospital admission (P ＜ 0.05 ),limb lesions involving the trunk (P ＜ 0.01 ),creatine kinase level (P ＜ 0.05 ),and emergency incision and drainage ( P ＜ 0.01 ).Conclusions The most prominent clinical manifestations of vibrio necrotizing fasciitis are rapidly progressive local symptoms and signs,and sharp deterioration of systemic conditions.Delayed visiting,severe local lesions,and failure to emergency surgery may be the factors for poor prognosis.

OBJECTIVE To study the changes in matrix metalloproteinase-9 (MMP-9) mRNA, tissue-inhibitor of metalloproteinase-1 (TIMP-1) mRNA and the ratio of MMP-9 mRNA/TIMP-1 mRNA in the lungs of paraquate poisoning rats, and to investigate the protective effects of sodium dimercaptopropane sulfonate (DMPS, Unithiol). METHODS One hundred and twenty male SD rats were divided into 12 groups (n=10) randomly: normal control, DMPS control, PQ poisoning 1, 3, 7, 14 and 28 d model groups, (DMPS+PQ) 1, 3, 7, 14 and 28 d groups. PQ poisoning model was established by intraperitoneal injecting paraquate. The expression of MMP-9 mRNA and TIMP-1 mRNA in lung tissues was detected by RT-PCR. RESULTS ①By observing the changes of action and observing the lung tissues sections, the rats' PQ poisoning models was successfully established. ②The histopathology of lung showed infiltration of inflammatory cell in acute phase(within 2 weeks), the inflammation decreased gradually after 2 weeks, hyperplasia of collagen and pulmonary fibrosis were instead. Howerer, the pathological changes were alleviated obviously in the (DMPS+PQ) groups. ③Compared with the PQ groups, the expression of MMP-9 mRNA and TIMP-1 mRNA in lungs diminished greatly in the DMPS+PQ groups after rats injected DMPS(P<0.05); the ratio of MMP-9/TIMP-1 mRNA was bigger at 7, 14 and 28 d in the DMPS+PQ groups after rats injected DMPS. CONCLUSION Down-regulation of the expression of MMP-9 mRNA and TIMP-1 mRNA and up-regulation ratio of MMP-9 mRNA/TIMP-1 mRNA by DMPS may be one of mechanisms by which pulmonary injury and pulmonary fibrosis are prevented in the acute paraquate poisoning.

Objective To study epidemiology, clinical findings, diagnosis and treatment of sepsis caused by Vibrio vulnificus. Method Patientss with Vibrio vulnificus sepsis were collected from 1995 to 2008. The medical records including epidemiological and clinical data were analyzed. Results The male-to-female ratio of 34cases was 4.7:1 and 76. 5% of these patients suffered from chronic liver disease. Most patients occurred from April to October with signs of abrupt fever, characteristic cutaneous lesions, hypotension and progressive multiple organ disfunction syndrome (MODS). The mortality was over 47.1% . The criteria proposed for early diagnosis of Vibrio vulnificus sepsis were abrupt onset with fever during the period from April to November, characteristic cutaneous lesions, such as the most commonly occurred haemorrhagic bullae on the extremities or even extensive necrosis of skin and muscular tissue, progressive hypotension or shock accompanied by MODS, pre-existing liver disease or chronic abuse of alcohol, and consumption of raw seafood or exposure to seawater within 12 week. Early administration of the third-generation cephalosporins with the quinolones in full dosage, aggressive wound debridement,appropriate dermoplasty and supportive care contribute to a better outcome. Conclusions Vibrio vulnificus sepsis progresses rapidly with high mortality. Early diagnosis, rapid treatment with prompt antibiotics and aggressive surgery treatment are very important to improve the outcome.

Objective To investigate the effect of resveratrol (Res) on paraquat (PQ)-induced acute lung injury (ALI) and mortality in mice and the mechanism of nuclear factor-κB (NF-κB) inflammatory pathway. Methods Sixty-eight healthy male ICR mice with grade SPF were enrolled, among them 20 mice were used for mortality observation (n = 10), and other 48 were used for determination of related parameters (n = 6). The mice were randomly divided into four group s: normal saline (NS) control group, Res control group, PQ group and PQ + Res group. The mice in the latter two groups were subdivided into 6, 24, 72 hours subgroups. The PQ poisoning model of mice was reproduced by one injection of 30 mg/kg PQ intraperitoneally. The mice in PQ + Res group were given 60 mg/kg Res intraperitoneally on the contralateral side after PQ injection. The mice were sacrificed at 6, 24, 72 hours after PQ poisoning, and lung tissue was harvested. The serum levels of tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-1β) were determined by enzyme linked immunosorbent assay (ELISA). The pathological changes in lung tissue were observed with electron microscopy. Apoptosis cells in the lung were identified by terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) for the estimation of apoptosis rate. The protein expression of NF-κB p65 was determined by Western Blot. Results Compared with PQ group, the death number of mice at 48, 72, 96 hours in PQ + Res group was slightly decreased (0 vs. 2, 2 vs. 5, 4 vs. 6) but without statistically significant difference (all P > 0.05). Under electron microscope, the lung injury in PQ group was severer than that in NS control group, and Res was found to be able to alleviate the lung injury. Compared with NS control group [(2.45±0.61)%], the apoptosis rate at 6 hours in PQ group was significantly increased [(8.42±1.48)%], and peaked at 72 hours [(21.23±3.47)%]. Res could decrease the apoptosis rate after PQ poisoning [6 hours: (5.56±1.31)% vs. (8.42±1.48)%, 24 hours: (11.14±2.07)% vs. (16.88±2.96)%, 72 hours: (13.28±2.32)% vs. (21.23±3.47)%, all P < 0.05]. The serum levels of TNF-α, IL-6, and IL-1β, and NF-κB p65 in lung tissue were all markedly increased after PQ poisoning, and they were significantly decreased after Res intervention as compared with those of PQ group [TNF-α (ng/L): 2.62±0.29 vs. 4.06±0.74 at 6 hours, 3.98±0.41 vs. 6.79±0.80 at 24 hours, 5.06±0.75 vs. 11.00±0.75 at 72 hours; IL-6 (ng/L): 14.19±1.54 vs. 16.55±1.24 at 6 hours, 13.21±1.37 vs. 19.73±0.85 at 24 hours, 13.72±0.56 vs. 22.45±0.72 at 72 hours; IL-1β (ng/L): 8.54±1.64 vs. 12.59±0.66 at 6 hours, 10.15±0.29 vs. 16.24±1.03 at 24 hours, 16.14±0.70 vs. 19.55±0.56 at 72 hours; 6-hour NF-κB p65: (1.34±0.07) folds vs. (1.86±0.11) folds when the expression in NS control group was represented as 1, all P < 0.05]. Conclusions Res cannot lower the mortality in mice with PQ poisoning, but it seems to be able to attenuate PQ-induced ALI and cell apoptosis. The mechanism responsible for the latter maybe the inhibitive effect of Res on NF-κB p65 translocation and cytokines production.