Objective:To observe the application effect of respiratory stepwise management in patients with septic shock combined with acute lung injury (ALI).Methods:100 patients with septic shock combined with ALI were selected as the research objects in Haikou Hospital Affiliated to Xiangya Medical College of Central South University from January 2018 to June 2020. Fifty patients were given endotracheal intubation or invasive ventilation on the basis of conventional treatment (conventional treatment group). According to the respiratory situation and blood gas, 50 patients were given systematic respiratory support step-by-step treatment according to the principle of simple to complex, and appropriate and scientific respiratory support was given according to the sequence from unarmed to mechanical (respiratory stepwise management group). The differences of cardiac index (CI), central venous pressure (CVP), mean arterial pressure (MAP), extravascular lung water index (EVLWI), arterial partial pressure of carbon dioxide (PaCO 2), arterial partial pressure of oxygen (PaO 2), oxygenation index (PaO 2/FiO 2) before and after treatment were compared between the two groups, the therapeutic effects of the two groups were evaluated, and the resuscitation effect, postoperative complications rate, tracheotomy rate, utilization rate of invasive ventilator of the two groups were recorded. Results:After treatment, CI, CVP, EVLWI, PaO 2, PaO 2/FiO 2 levels of the two groups were significantly higher than before treatment, MAP and PaCO 2 levels were significantly lower than before treatment; MAP and PaCO 2 levels after treatment of the respiratory stepwise management group were significantly lower than those of the conventional treatment group [MAP (mmHg, 1 mmHg = 0.133 kPa): 68.2±7.0 vs. 74.4±6.8, PaCO 2 (mmHg): 37.82±4.05 vs. 41.76±4.59], the levels of EVLWI, PaO 2 and PaO 2/FiO 2 in the respiratory stepwise management group were significantly higher than those in the conventional treatment group [EVLWI (mL/kg): 15.34±3.03 vs. 13.64±3.32, PaO 2 (mmHg): 84.44±4.83 vs. 79.03±5.54, PaO 2/FiO 2 (mmHg): 452.42±51.32 vs. 431.73±50.03, all P < 0.05]. There was no significant difference in CI or CVP after treatment between respiratory stepwise management group and conventional treatment group [CI (mL·s -1·m -2): 70.01±21.67 vs. 66.68±18.34, CVP (mmHg): 11.1±3.2 vs. 12.3±3.2, both P > 0.05]. Compared with the conventional treatment group, the average recovery time of the respiratory stepwise management group was earlier (hours: 2.04±0.54 vs. 4.29±0.20, P < 0.05), the stable breathing time was shorter (hours: 3.07±0.22 vs. 5.36±0.35, P < 0.05), the total effective rate and the success rate of recovery were significantly improved [86.0% (43/50) vs. 60.0% (30/50), 94.0% (47/50) vs. 74.0% (37/50), both P < 0.05], the incidence of ventilator associated pneumonia (VAP) and airway complications were significantly reduced [14.0% (7/50) vs. 32.0% (16/50), 12.0% (6/50) vs. 40.0% (20/50), both P < 0.05], and the tracheotomy rate and the utilization rate of invasive ventilator were significantly reduced [8.0% (4/50) vs. 28.0% (14/50), 30.0% (15/50) vs. 60.0% (30/50), both P < 0.05]. Conclusion:Respiratory stepwise management can effectively improve the resuscitation effect of septic shock patients with ALI, improve cardiopulmonary function, blood gas index and the treatment efficiency, effectively reduce the incidence of iatrogenic trauma and complications.

Objective To study the volume of lateral cerebral ventricle in neonates with threedimensional ultrasonography(3F-US),and to investigate the influence of sex,body weight(BW),head circumference(HC)and gestational age(GA) on it. Methods A total of 255 healthy neonates (GA 28~40 weeks) were examined with 3D cranial ultrasound. The ultrasonography was performed with anterior fontanel as the acoustic window,and the data were aquired at the deck of third ventricle on coronal section.The 3D image on the screen was constructed automatically and the volume of lateral cerebral ventricle was (P=0.809),and there was negative correlation between the volume of lateral cerebral ventricle and GA(r=-0.971). The correlation between the volume of lateral cerebral ventricle and HC was positive(r≥According to the relationships among HC(X 1),GA(X 2)and volume of lateral cerebral ventricle(Y),a linear regression equation Y=2.298-0.011 X1-0.04 X2 was obtained(the determinate coefficient R2 was accurately,which would be helpful to the evaluation on the cerebral maturity and the diagnosis of cerebral desease in neonates without wound.

To investigate whether the Bcl-2 gene family is involved in modulating mechanism of apoptosis and change of cell cycle protein induced by curcumin in acute myeloid leukemia HL-60 cell line and primary acute myelogenous leukemic cells, the Bcl-2 family member Mcl-1, Bax and Bak and cell cycle proteins including P27kipl, P21wafl, cyclin D3 and pRbp- were selected and their expression detected by SABC immuno-histochemical stain method. The attitude of sub-G1 peak in DNA histogram was determined by FCM. The TUNEL positive cell percentage was identified by terminal deoxynucleotidyl transferase (TdT)-mediated Biotin dUNP end labeling technique. It was found that when HL-60 cells were treated with 25 mumol/L curcumin for 24 h, the expression level of Mcl-1 was down-regulated, but that of Bax and Bak up-regulated time-dependently. There was significant difference in the expression level of Mcl-1, Bax and Bak between the curcumin-treated groups and control group (P < 0.05-0.01). At the same time, curcumin had no effect on progress of cell cycle in primaty acute myelogenous leukemia at newly diagnosis, but could increase the peak of Sub-G1 (P < 0.05), and down-regulate the expression of Mcl-1 and up-regulate the expression of Bax and Bak with the difference being statistically significant. The expression of P27kipl, P21wafl and pRbp- were elevated and that of cyclin D3 decreased in the presence of curcumin. These findings suggested that the Bcl-2 gene family indeed participated in the regulatory process of apoptosis induced by curcumin in HL-60 cells and AML cells. Curcumin can induce apoptosis of primary acute myelogenous leukemic cells and disturb cell cycle progression of HL-60 cells. The mechanism appeared to be mediated by perturbing G0/G1 phases checkpoints which associated with up-regulation of P27kipl, P21wafl and pRbp- expression, and down-regulation of cyclin D3.
Antineoplastic Agents, Phytogenic/pharmacology ; Apoptosis/*drug effects ; Cell Cycle Proteins/*metabolism ; Curcumin/*pharmacology ; Genes, bcl-2/genetics ; HL-60 Cells ; Leukemia, Myelocytic, Acute/pathology ; Neoplasm Proteins/biosynthesis ; Neoplasm Proteins/genetics ; Proto-Oncogene Proteins/biosynthesis ; Proto-Oncogene Proteins/genetics ; Proto-Oncogene Proteins c-bcl-2/*metabolism ; Tumor Cells, Cultured ; bcl-2-Associated X Protein

Objective:To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods:Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019. All 4 cases were cardiac death donors. There were 3 males and 1 female donors, aged (54 ± 22.69) d and weighing (5.6 ± 0.79) kg. There were 1 male and 3 female recipients, aged (41.5 ± 5.97) years and weighing (45 ± 3.56) kg. For lowering operative difficulties and preventing hemodynamic disturbances, bilateral kidneys were sutured and fixed during trimming. Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results:All operations were successful without vascular or urinary complication. The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min. The functions of transplanted kidney recovered well during a follow-up period of 12 months. The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions:The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling. With a higher success rate, vascular complications are lowered. A wider popularization is recommended.

Chinese patent medicines Compound Danshen Dripping Pills (DSP) and Di'ao Xinxuekang (DXK) capsules were both found effective in treating angina pectoris. However, there is no systematic review comparing their efficacy.

Objective To detect the expression of VEGF in NHL and analyze the relation of the expression levels with malignant aggressiveness,treatment response,and prognosis.Methods The expression of VEGF in lymph nodes taken from 39 NHL patients Wag measured by immunohistochemical-staining method.9 patients with benign lymphadenopathy were acted as control.Results The expression of VEGF in NHL(79.5%)was higher than that in the contrel(44.4%)(P=0.048＜0.05).In NHL,the VEGF level was higher in aggressive lympboma than that in indolent lymphoma(x2=5.284,P=0.044＜0.05).The patients had the higher-level expression as the Ann Arbor stage Wag higher,and the patients who had the higher-level expression of VEGF had higher serum LDH level,lower chemotherapy remission,unfavorable prognosis and lower 3-year survival (P＜0.05).Conclusion The expression of VEGF in NHL was increased.It was correlated with histopathological grade,Ann Arbor stage,chemotherapy response and prognosis.

Objective To investigate the effect of membrane-bound prostaglandin E2 synthase 1 (mPGES-1) inhibitor MK886 on cell cycle of the human acute myeloid leukemia HL-60/A cells.Methods Flow cytometry,Western blot and ELISA were used to measure the difference of cell cycle,expression of cyclin D1, mPGES-1 among HL-60/A cells,MNC and HL-60 cells.The effect of MK886 on cell cycle,cyclin D1,mPGES-1,PGE2,P-Akt and c-myc of HL-60/A cells were observed.Results Compared with MNC and HL-60 cells,the expression of cyclin D1 and mPGES-1 were higher in HL-60/A cells,the percentage of G0-G1 phase was decreased [MNC (62.63±6.58) ％,HL-60 (38.86±2.25) ％,HL-60/A (30.53±2.15) ％]and S phase increased[MNC (12.18±4.43) ％,HL-60 (47.70±1.88）％,HL-60/A (57.56±1.54) ％](all P＜ 0.05).After treated with MK886,cell cycle was arrested in G0-G1 phase.The expression of mPGES-1,cyclin D1,P-Akt and c-myc and synthesis of PGE2 were decreased.Conclusion MK886 can arrest HL-60/A cell cycles in G0-G1 phase,which possibly through down-regulation of mPGES-1/PGE2,reduction cyclin D1,P-Akt and c-myc expression.

Objectiye To investigate the effect of selective COX-2 inhibitor, nimesulide, on inhibiting proliferation of the human acute myeloid leukemia HL-60 cells. Methods HL-60 cells were treated with different concentration of nimesulide. HL-60 cell proliferation was examined by CCK-8 method. Flow cytometry, Western blotting and ELISA were used to measure the effect of nimesulide on apoptosis, cell cycle,COX-2, PGE2, bax, bcl-2 and c-myc. Results Nimesulide inhibited HL-60 cells proliferation in a dose and time dependence manner. Nimesulide induced cell apoptosis and arrested cell cycle in G0-G1 phase. The expression of COX-2 protein declined after treated with nimesulide 48 h, the total apoptosis in 100, 200,400 μmol/L nimesulide-treated group and control group were (24.97 ± 6.36) %, (34.22 ± 5.76) %, (44.59 ±6.69) % and (4.11 ± 1.26) %, there were significant differences (P ＜ 0.05). Nimesulide inhibited the synthesis of PGE2, the expressions of bcl-2 and c-myc protein and upregulated the expression of bax protein simultaneity.Conclusion Nimesulide significantly inhibited the proliferation of HL-60 cells and induced cell apoptosis,which may be associated with the downregulation of COX-2 expression, reduction of PGE2 synthesis, arrest of cell cycle and regulation bcl-2, c-myc and bax protein expression.

Objective To explore the correlation of atheroselerosis progression and the expression of platelet derived endothelial nitric oxide synthase (eNOS) in rabbits. Methods A total of 24 male New Zealand white rabbits were used in this study. Six of the animals were fed with normal food (control group). Eighteen rabbits were fed with cholesterol-rich food (1 g/d) for 12 weeks to establish the atherosclerosis model. Among 18 models, 6 rabbits were executed immediately and their aorta and platelet samples were collected for further analysis (model group), 6 rabbits were orally administered with pravastatin (10 rag/d) for additional 12 weeks (treated group), and the remaining 6 rabbits were left untreated until the end of the study (untreated group). The control, treated and untreated animals were then killed, and the aorta and platelet samples were collected for eNOS expression analysis (RT-PCR). Results The aorta samples in model and untreated group exhibited rough intima and a lot of longitudinal fatty streaks, which indicated that atherosclerosis models were established successfully. While in treated group, the degree of atherosclerosis was decreased. The average percent of thickness of fatty streaks or atheroselerotic plaques relative to the whole thickness of vessel walls was 0. 04±0. 02, 0. 82±0. 16, 0. 33±0. 18,0. 77±0. 14 in control, model, treated and untreated group, respectively. The thickness of fatty streaks or atherosclerotic plaques was significantly increased in the model and untreated groups and decreased in treated group compared with the control group (both P<0. 05). The expressions of platelet derived eNOS/mRNA were 1. 02± 0. 28, 0. 41± 0. 27, 1.00 ± 0. 77, 0. 40±0. 29 in control, model, treated and untreated group, respectively. The expression of eNOS/mRNA was markedly decreased in model group and untreated group compared with the control group, but was increased in treated group compared with untreated and model groups (F=3. 544, P = 0. 024). Conclusions There is a negative correlation between eNOS expression and atherosclerosis development, which suggests that the reversal effect of pravastatin on atheroselerosis progression and plaque formation may relate to the expression of platelet derived eNOS.

Objective To investigate the function and necessity of ICU to supervise and cure the patients after comprehensive correction of facial skeletal contouring. Methods 178 patients were examined carefully and perfectly before operation to obviate taboo. After comprehensive correction of facial skeletal contouring operation, all the patients were transferred into ICU in order to be supervised and cured comprehensively. Results 26 (14. 61 %) patients had hypoxemia ( SPO2 ≤90 %),11(6. 18 %)kaliopenia (K+≤3. 5 mmol/L) and 18 (10. 11 %) hypertension. 21 patients appeared arhythmia. Among these 21 arhythmia patients, 15 (8.43 %) patients had pyknocardia (HR≥100/min), 3 (1. 69 %) atrial premature beat, 1 (0.56 %) fibrillation atrial, 2 (1. 12 %) premature ventricular contraction, 1 (0. 56 %) Ⅱ degree atrioventricular block. 8 patients had respiratory tract obstruction. 2 (1. 12 %) had hemorrhea of mandible and 1 transfused 600 ml blood. 17 (9. 55 %) patients had restlessness. 65 patients had nausea and vomitting. All patients in ICU having postoperative complications had been deal with corresponding management. There were no respiratory failure,hemorrhagic shock, cardiac arrest after operation in 178 patients. Conclusions ICU can offer timely, continuous, and systemic supervision and cure to patients after comprehensive correction of facial skeletal contouring,and reduce the postoperative emergency rate.