Objective To study the clinical efficiency and possible side effects of lower tidal volume combined with sustained inflation(SI) on acute respiratory distress syndrome (ARDS) for post operative carcinoma surgery patients.Methods Fifty one hypoxemia post operative carcinoma surgery patients from Jan.2007 to Dec.2009 in Cancer Hospital and Institute,Chinese Academy of Medical Sciences and Peking Union Medical College were included.Their cirrculation was stable.Mechanical ventilation could not be removed due to ARDS.Noninvasive continuous artery blood pressure ( NBP),pulse oximetric saturation ( SPO2 ),arterial blood gas ( ABG ) analysis,static compliance of respiratory system (Cst) were monitored and recorded.Patients were ventilated on volume control mode.Tidal volumes (VT) was set to 6 ml/kg.SI were conducted by continuous positive airway pressure of 35 cm H2O,sustaining for 40 seconds.Positive end-expiratory pressure (PEEP),FiO2,respiratory rate (F),Pplateau inspiratory pressures (Pplat),the peak inspiratory pressures (Ppeak),VT,Cst and ABG before SI applying and at 10 min,24 h,48 h after SI applying were measured.Results The level of PaO2 and FiO2 were significantly lowered,VT and Crs increased significantly,Ppeak,Pplat,and F were improved significantly at 10 min,24 h and 48 h after SI in all cases.No complication occurred.All patients were discharged without adverse event.Conclusions Hypoxemia of ARDS following carcinoma surgery could be improved by lower tidal volume combined with SI.

AIM To evaluate the possible role of endogenous nitric oxide (NO) in the development of lung injury after hind limbs ischemia reperfusion (LIR), and the effect of taurine on endogenous NO on the model of lung injury following LIR. METHODS Wistar rats were divided into three groups: control group, ischemia reperfusion group (IR) and taurine+IR (Tau+IR). The changes of PaO 2 ,PaCO 2,lung index (LI) and lung permeability index (LPI) were observed. The content of malondialdehyde (MDA), NO and endothelin (ET) in both plasma and the lung as well as the content of nitric oxide synthase (NOS) and taurine in the lung were detected. The immunohistochemical method was used to detect level in the expression of NOS protein. RESULTS Taurine improved the pulmonary respiratory following LIR significantly, lightened lung edema, decreased the content of ET in both plasma and lung tissue, increased the content of NO in both plasma and lung tissue and promoted the level in the expression of NOS protein. CONCLUSION Using taurine may lighten lung injury following LIR and this protective effect may due to increasing the content of endogeneous NO and decreasing the level of ET.

AIM: To investingate the potential role of apoptosis in the development of acute lung injury(ALI) following limbs ischemia-reperfusion(LIR) in rats and the effects of raurine. METHODS: The model of LIB injury in rats was made. By using TUNEL, electrophoresis, reverse-transcription polymerase chain reaction(RT-PCR) and immunohistochemistry techniques, pulmonary apoptosis, Fas/FasL expressions and Ca~(2+), reactive oxygen species (ROS),the ratio of DNA double chain in tissue were detected in different groups.RESULTS: The rapid appearance of apoptosis in alveolar epithelial cells and pulmonary vascular endothelial cells were observed after LIR in rats. The ratio of DNA double chain decreased and tissue Ca~(2+) increased. The expression of Fas/FasL mRNA and protein was up-regulated in lung tissue of rats after LIR, which was related to the elevation of alveolar epithelial cells and pulmonary vascular endothelial cell apoptosis. Taurine decreased alveolar epithelial cell and pulmonary vascular endothelial cell apoptosis not by down-regulating expression of Fas/FasL system. CONCLUSIONS: These results suggest that the excessive apoptosis and Fas/FasL system expression may play a role in the pathogensis of ALI following LIB in rats, and taurine decreases alveolar epithelial cell and pulmonary vascular endothelial cell apoptosis.

BACKGROUND: Limb ischemia reperfusion (LIR) as a stressor leads to gastric mucosal injury, and then results in the occurrence of stress ulcer.OBJECTIVE: To observe the effects of LIR on gastric mucosal injury, investigate part of the mechanism, and the role of several transient limb ischemia in the occurrence of gastric mucosal injury.DESIGN: A randomized grouping design and controlled animal experiment.SETTING: Department of Pathophysiology of North China Coal Medical College.MATERIALS: The experiment was carried out in the pathophysiological laboratory of North China Coal Medical College from January to June 2002. Fifty-four healthy adult male Wistar rats were randomly divided into three groups with 18 rats in each group. Ischemia reperfusion (I/R) group: The rats were duplicated into models according to the Rosenthal method that under superficial anesthesia with ether, the roots of both hindlimbs were ligated by wrapping with rubber strap, blood flow was blocked for 4 hours and then recovered to perfusion for 4 hours, and finally killed by bleeding from abdominal aorta. Ischemic preconditioning group: Before model establishment, blood flow of both hindlimbs was blocked for 5 minutes, and then recovered to perfusion for 5 minutes, which was repeated for four times, and the following operations were the same as those in the I/R group. Control group: The operations were the same as those in the I/R group,but both hindlimbs were ligated at relaxation without blocking the blood flow.METHODS: Sections of gastric mucosa were prepared, and then observed under light microscope and electron microscope, and the index of gastric mucosal injury was determined according to the Guth standard. The colorimetric assay was performed with 721 spectrophotometer at 650 nm, and the amount of gastric combining mucus was calculated.Meanwhile, the blood flow of gastric mucosa, contents of phospholipid and hexosamine in gastric mucus, content of nitric oxide in plasma and gastric tissue and activity of nitric oxide synthase (NOS) in gastric mucosa were determined.MAIN OUTCOME MEASURES: Index of gastric mucosal injury, amount of gastric combining mucus, blood flow of gastric mucosa, contents of phospholipid and hexosamine in gastric mucus, contents of nitric oxide in plasma and gastric tissue and NOS activity in gastric mucosa.RESULTS: All the 54 rats were involved in the analysis of results. ① In the I/R group, gastric mucosal injury was serious, edema, hyperemia, erosion and disintegration of gland of mucosal glands were observed, infiltration of inflammatory cells (formation of ulcer) was observed in basal and inferior mucosa. In the ischemic preconditioning group, the gastric mucosa was complete, and the damaged severity was milder than that in the I/R group; Under electron microscope, the organell structures of gastric parietal and chief cells were incomplete and destroyed. The cell injuries in the ischemic preconditioning group were milder than those in the I/R group (index of injury: 18.00±10.71, 34.00±15.01, P＜ 0.01). ② The blood flow and combining mucosal amount of gastric mucosa, contents of phospholipid and hexosamine in gastric mucus in the ischemic preconditioning group and I/R group were all obviously lower than those in the control group [(2.12±0.56), (10.84±2.56), (25.52±2.97) mL/(kg·h); (2.01±0.91), (2.79±0.73), (3.99±0.87) mg;(7.68±1.95), (9.74±1.04), (11.98±1.98) mg/g; (3.83±1.18), (5.42±0.47), (5.76±1.21) mg/g, P ＜ 0.05, 0.01], those the above indexes were all higher in the ischemic preconditioning group than in the I/R group. ③ The contents of nitric oxide in plasma and gastric tissue and NOS activity in gastric mucosa in the ischemic preconditioning group and I/R group were significantly lower than those in the control group [(250.0±5.6), (270.0±11.3), (210.0±7.4) μmol/L; (9.34±0.67), (11.34±1.00), (7.50±0.67) μ kat/g, P ＜ 0.01], those were also signficantly higher in the ischemic preconditioning group than in the I/R group.CONCLUSION: As a stressor, LIR can lead to gastric mucosal injury, and cause stress ulcer.Ischemic preconditioning can alleviate the gastric mucosal injury following LIR

AIM: To observe the degree of gastric mucosal injury following limb ischemia/reperfusion(LIR),and to investigate the mechanism of gastric mucosal injury and the influence of the series of brief ischemia/reperfusion of hind limbs of rats on gastric mucosal injury. METHODS: Referring to Rosenthal's method, the model rats which underwent 4 hours of ischemia and 4 hours of reperfusion in hind limbs were made. The indexes of gastric mucosal injury after LIR and ischemic preconditioning (IPC) + LIR were determined. The morphologic changes were observed with light microscope and transmission electron microscop respectively. The GMBF,histologic lesion score, gastric barrier mucus, phospholipids, hexosamine, nitric oxide and nitric oxide synthase in mucus were measured in different groups. RESULTS: Serious damage in gastric mucosa was observed under microscope and EM after LIR. But less serious damage was observed in the IPC group. After LIR, compared to the control group, the GMBF and the content of gastric barrier mucus, phospholipids and hexosamine in mucus decreased significantly. There was significant difference in most indexes between the control group and the IPC group, but compared to LIR group, the histologic lesion score decreased significantly and the GMBF and the content of gastric barrier mucus, phospholipids, hexosamine ,nitric oxide and nitric oxide synthase in mucus increased significantly. CONCLUSION: LIR caused the gastric mucosa injury. IPC alleviated the damage of gastric mucosa following ischemia/reperfusion in hind limbs.

Objective To establish a method of quick three-dimensional (3D) reconstruction of pubic symphysis based on magnetic resonance imaging. Methods The pelvis images of adult male were generated on a 3.0 T scanner using a T1 Gradient Echo FLASH-3D (T1- FL3D) sequence and imported the images into medical image control system. Segmentation of binaryzation threshold was conducted and pelvic soft tissue image was extracted by regional growth, 3D structure model of pubic symphysis was obtained by Boolean operation. The 3D structure model of pubic symphysis was established by the noise reduction of reverse engineering software. And compared with the 3D reconstruction model pubic bone CT scan. Results The morphological characters of the MRI pubic symphysis 3D model, such as the ridges and furrows on the symphysial surface, lower extremity, dorsal margin (beveling), margin (beveling) and pubic tubercle, were highly consistent with the morphological characters of the 3D model established by CT scan. Conclusion MRI scan can be used to reconstruct the 3D structure of pubic symphysis quickly and effectively, and it can provide a safe radiation-free 3D visualization imaging technique for forensic age estimation for the living.

【Objective】 To establish deferral criterion of HIV ELISA (enzyme-linked immunosorbent assay) and electrochemiluminescence immunoassay(ECLIA) by using receiver operating characteristic curve(ROC) method to screen HIV reactive blood donors suitable for entering the re-entry process and improve the management efficiency of reactive blood donors. 【Methods】 The test results of 92 001 blood donors from February to September 2019 were analyzed, and 177 reactive samples were screened by conventional screening mode (twice ELISA and once nucleic acid), supplemented with electrochemiluminescence immunoassay assay (ECLIA), and confirmed by Western blotting (WB). Screening reactive samples were divided into three groups: group A was both serological and nucleic acid reactivity, group B was only serological reactive, and group C was only nucleic acid reactivity. Its efficacy in blood donor classification was assessed by drawing ROC curves with 99% specific corresponding S/CO low values as the deferral criterion of the corresponding serological method. 【Results】 1) A total of 177 HIV reactive samples were detected in conventional mode, including 34 in group A, 142 in Group B and 1 in Group C. The positive predictive value (PPV) was 100%, 0.75% and 100%, respectively. ECLIA detection mode (once ECLIA and once NAT), a total of 67 HIV reactive samples including 34 in group A, 32 in group B and 1 in group C, with positive predictive values of 100%, 3.7% and 100%, respectively.2) The HIV test results showed diversity, with 36 true positive samples including 1 HIV elite controller and 3 early HIV infections (1 HIV ELISA antigen/antibody window and 2 ELISA HIV antibody window), and 32 serological and NAT cases were reactive infections.3) The deferral limit of ELISA 1 and ELISA 2 in conventional screening mode were 20.25 and 9.85, respectively, can screen 97.14% (34/35) of all true positive samples in group A and B, except for one ELISA HIV antibody window (ELISA 2 reactivity). The positive predictive values were 93.94% and 92.85%, respectively. The ECLIA deferral limit of 7.83 can screens all true positive samples in Groups A and B (35/35)in ECLIA mode. The positive predictive value was 94.59%. 【Conclusion】 The establishment of deferral limits in this study can effectively screen HIV-positive blood donors, and the number of screened blood donors is greatly reduced, which is helpful to fine and scientific management of HIV-reactive blood donors. The deferral limit values of different testing reagents are quite different, so each laboratory should choose appropriate testing methods to establish the deferral limit values suitable for the laboratory according to its own testing ability, so as to provide technical support for optimizing the process of returning blood donors to the team.

【Objective】 To perform electrochemiluminescence immunoassay (ECLIA) and Western blotting (WB) confirmation tests for HIV reactive samples in blood screening, and analyze the correlation between ELISA (enzyme-linked immunosorbent assay), ECLIA results and confirmed infection, so as to provide data support for the application of ECLIA in blood screening. 【Methods】 177 HIV reactive samples in blood screening testing detected by our laboratory from February to October 2019 were collected, of which 137 were reactiv to isolated ELISA reagent e, 39 to dual ELISA reagent, and 1 in window period. Ten maker-negative samples were randomly selected to undergo ECLIA with the above 177 samples. HIV reactive samples were sent to Centers for Disease Control and Prevention (CDC) for confirmation tests, and the results were analyzed and compared. 【Results】 Among the 177 HIV reactive samples, 66 were ECLIA reactive, 111 negative, and the 10 maker-negative samples remained negative. The sensitivity, specificity, positive predictive value, negative predictive value and total concordance rate of ECLIA were 97.1%, 81.1%, 55%, 99.1% and 84.2%, respectively, showing better performance than that of two ELISA reagents(P<0.05) with exception of sensitivity(P>0.05). The positive predictive value and specificity were tested by chi-square test, and the difference between ECLIA and reagent 2 was statistically significant (P<0.05). The ECLIA results showed significant correlation with the confirmation results with good consistency(examed by Kappa test). Among the three reagents, ECLIA presented highest accuracy and largest Youden index. 【Conclusion】 ECLIA presents high detection sensitivity, which can improve the detection ability of early HIV infection and shorten the window period of HIV detection, therefore should be popularized in blood screening.