Objective To observe the attenuated and synergistic effect of meteorism tablets in treating HBeAg-positive chronic hepatitis B patients. Methods Eighty patients of HBeAg-positive chronic hepatitis B were randomly divided into treatment group (meteorism tablets combined with telbivudine) and control group (telbivudine), and treated for one year. The changes of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the negative rate of HBV-DNA, the negative rate of HBeAg, HBeAg/HbeAb serological conversion rate, creatine kinase (CK) before and after treatment, and safety were observed. Results After treatment, biochemical response, virological response and HBeAg serological response was more significant in the treatment group than that in the control group (P<0.05). The percetage of patients with elevated CK in the treatment group was significantly lower than that in the control group (32.5% vs 60%, P<0.05). Conclusion Meteorism tablets combined with telbivudine has attenuated and synergistic effect in treating HBeAg-positive chronic hepatitis B patients.

Objective:To observe the effect of Weijinkang Oral Liquid on rats'models with siliconic nodules and the diffuse fibrosis of the lungs.Methods:45 rats were randomly divided into the blank group,dust-affected group,and treatment group.The rats in the blank group were fed in normal environment.The rats in the dust-affected group were given regular feed.The dust-affected rats in the treatment group were administrated 1.0mL/100g of Weijinkang condensed liquid in 30% by stomach perfusion,two times daily(33 times of human's dosage).Five of each group were killed and anatomized in turn on the 15th day,the 30th and the 90th day.Results:On the 90th day the pathological test showed massive cartilaginous changes projecting to the pulmonary surface in the dust-affected group.There was no abnormality of lungs in both treatment group and blank group.After receiving Weijinkang Oral Liquid the rats in the treatment group showed greater weights than those in the dust-affected group,and the weights of fresh and dehydrated lungs were lighter than those in dust-affected group.Conclusion:Weijinkang Oral Liquid had certain effect on siliconic nodules and the diffuse fibrosis of the lungs caused by pneumonoconiosis.

Objective To evaluate the value of serum procalcitonin (PCT)on antibiotic use in treatment of community acquired pneumonia (CAP) in outpatient. Methods From November 2006 to February 2008, a total of 127 patients with CAP in outpatient were randomly assigned into two groups:PCT group(n=63)and control group(n =64). PCT levels of all patients were measured after study admission. On the base of similarly normal treatment, the control group received antibiotics according to the attending physicians and the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level ≥ 0. 25 μg/L and was discouraged with PCT level < 0.25 μg/L. Clinical efficacy, rate of antibiotics use, duration courses and costs of antibiotics were observed. Results Clinical efficacy of the PCT group was similar with the control group (92.1% vs 87.5%, P >0.05) ;rate and costs of antibiotics use was lower, antibiotic duration of the PCT group was shorter than that ofthecontroigroup(P<0.05,P<0.001,P<0.001).Conclusion PCT could be used in treatment of CAP for antibiotic use in outpatient, which may reduce antibiotic use, shorten antibiotic duration and lower costs of antibiotic.

Objective To evaluate the predicting value of serum procaleitonin (PCT) in treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in elderly patients. Methods A total of 267 elderly patients requiring hospitalization for AECOPD were randomly assigned into 2 groups: standard therapy group (standard group, n= 135) and PCT-guided group(PCT group, n= 132). Standard group received antibiotics according to the guideline of attending physicians and PCT group were treated with antibiotics according to serum PCT levels.Length of hospitalization, clinical efficacy, costs of hospitalization and antibiotics, rate of antibiotics use, hospital mortality, rate of exacerbation and rehospitalization, frequency of exacerbation within 1 year were observed. Results Length of hospitalization, clinical efficacy, hospital mortality, rate of exacerbation and rehospitalization, frequency of exacerbation within 1 year were similar in 2 groups(all P＞0.05);costs of hospitalization and antibiotics, rate of antibiotics use of PCT group[10 882 (3808-16 651)yuan, 6934 (2390-10 660)yuan, 76.5%] were lower than those of standard group[13 637(4650-19 730)yuan, 8589(3144-12 117)yuan, 87.4%] (all P＜0.05). Conclusions PCT guidance offers an advantage over standard therapy in reducing antibiotic use and in lowering the costs of hospitalization in treatment of AECOPD in elderly patients.

Objective To evaluate the value of serum procalcitonin(PCT)on antibiotics use in treatment of acute exacerbations of chronic obstructive pulmonary disease( AECOPD). Method From May 2004 to December 2006, a total of 235 patients requiring hospitalization for AECOPD were randomly assigned into two groups: standard therapy group(group A, n = 117)and PCT-guided group(group B, n = 118) .PCT levels of all patients were measured after hospital admission by an amplified cryptate emission technology assay. On the base of similarly normal treatment, group A received antibiotics according to the attending physicians,and group B were treated with antibiotics according to serum PCT levels:antibiotic treatment was applied with PCT level ≥0.25 ng/ml and was discouraged with PCT level ＜0.25 ng/ml. Length of hospitalization,clinical efficacy,costs of hospitalization and antibiotics, rate of antibiotics use, hospital mortality,rate of exacerbation and rehospitalization within 1 year were observed. Analyses were performed by t test, Mann-Whitney U test or χ2 test. Results Clinical efficacy, hospital mortality, length of hospitalization, rate of exacerbation and rehospitalization within 1 year were similar in two groups (P =0.635,0.768,0.884,0.747,0.727) ;costs of antibiotics and hospitalization,rate of antibiotics use of PCT-guided group were lower than that of standard therapy group( P = 0.029,0.036,0.014). Conclusions PCT could be used in treatment of AECOPD for antibiotic use after hospital admission,which may reduce antibiotic use and lower costs of antibiotic and hospitalization.

OBJECTIVETo determine the levels of MMP-2 and COX-2 mRNA in bladder transitional cell carcinoma tissues and explore their relationship.

METHODSWe enrolled in this study 42 patients with bladder transitional cell carcinoma, including Ta-T1 (n = 18), T2-T4 (n = 24), G1 (n = 12), G2 (n = 19), G3 (n = 11), metastasis (n =26) and non-metastasis (n = 16). Another 5 cases of normal bladder tissues were taken as controls, and the levels of MMP-2 and COX-2 mRNA were detected by RT-PCR.

RESULTSThe relative expressions of COX-2 mRNA were 1.038 +/- 0. 484 in Ta-T1, 1.489 +/- 0.584 in T2-T4, 0.920 +/- 0.442 in G1, 1.338 +/- 0.584 in G2 and 1.632 +/- 0.515 in G3, all significantly higher than that of the controls (0.460 +/- 0.224, P < 0.05). And the corresponding relative levels of MMP-2 mRNA were 1.107 +/- 0.384, 1.604 +/- 0.425, 0.971 +/- 0.370, 1.445 +/- 0.378 and 1.755 +/- 0.387, also significantly higher than that of the latter group (0.423 +/- 0.227, P < 0.05). The COX-2 and MMP-2 mRNA levels in the tumor tissues with and without metastasis were 1.591 +/- 0.455 vs 0.815 +/- 0.430 and 1.676 +/- 0.339 vs 0.927 +/- 0.228, (P < 0.01), respectively, with a positive correlation between the mRNA level of COX-2 and that of MMP-2 (r = 0. 703, P < 0.01).

CONCLUSIONMMP-2 and COX-2 mRNA are highly expressed in bladder transitional cell carcinoma tissues and their expressions are positively correlated with the degree of malignancy. MMP-2 and COX-2 might play a synergetic role in the pathogenesis and progression of bladder transitional cell carcinoma.

Adult ; Aged ; Carcinoma, Transitional Cell ; metabolism ; pathology ; Cyclooxygenase 2 ; biosynthesis ; genetics ; Female ; Humans ; Matrix Metalloproteinase 2 ; biosynthesis ; genetics ; Middle Aged ; Neoplasm Staging ; RNA, Messenger ; genetics ; Urinary Bladder Neoplasms ; metabolism ; pathology

Objective To explore the role and mechanism of exosomes derived from bone marrow mesenchymal stem cells(BMSCs)overexpressing transglutaminase 2(TGM2)in lactate-mediated oxidative stress-induced apoptosis in nucleus pulposus cells.Methods Twenty 6-week-old male SD rats(350±50 g)were used to extract nucleus pulposus cells.Lactic acid was utilized to establish a model of oxidative stress-induced apoptosis in primary nucleus pulposus cells.Lentiviral vectors carrying TGM2 were employed to transfect BMSCs to overexpress the protein,and then exosomes were extracted from the BMSCs and identified.Subsequently,to investigate the potential mechanisms of TGM2-overexpressing exosomes against oxidative stress-induced apoptosis in nucleus pulposus cells,flow cytometry was used to detect the production of reactive oxygen species(ROS),and Western blotting and immunofluorescence assay were applied to measure the expression levels of Bax,Bcl-2,Cleaved-Caspase3,p-PI3K,p-Akt,n-Nrf2,c-Nrf2 and HO-1,and Nrf2 nuclear translocation.The rate of oxidative stress-induced apoptosis in nucleus pulposus cells and changes in the PI3K/Akt/Nrf2 pathway were assessed in 4 groups of cells(n=3):control group,lactate treatment group,lactate+control exosome group,and lactate+TGM2-overexpressing exosomes group.Results Lactic acid of 10 mmol/L was found to be more effective in inducing oxidative stress-induced apoptosis in nucleus pulposus cells(P＜0.05).Both control BMSCs and TGM2-overexpressing BMSCs could produce exosomes and stably overexpress TGM2(P＜0.05,P＜0.01).Compared with the lactate treatment group,the nucleus pulposus cells in the lactate+TGM2-overexpressing exosome group and the lactate+control exosome group showed reduced apoptotic rates(P＜0.05),as well as decreased ROS level(P＜0.05).The lactate+TGM2-overexpressing exosome group exhibited better anti-apoptosis and ROS accumulation effects(P＜0.05).Additionally,the expression of Bax and Cleaved-Caspase3 was decreased(P＜0.05),that of Bcl-2 protein was increased(P＜0.05),the phosphorylation of PI3K/Akt was enhanced(P＜0.05),and both Nrf2 nuclear translocation and the expression of the antioxidant stress factor HO-1 were increased in nucleus pulposus cells.The lactic acid+TGM2-overexpressing exosome group showed stronger anti-apoptotic effects and activation of the PI3K/Akt/Nrf2 pathway(P＜0.05).Conclusion Exosomes derived from BMSCs overexpressing TGM2 can inhibit lactate-mediated oxidative stress-induced apoptosis in nucleus pulposus cells,and the mechanism may be related to the activation of the PI3K/Akt/Nrf2 pathway.

Objective: To investigate the resuscitation effect of aortic balloon occlusion (ABO) on the traumatic cardiac arrest (TCA) in swine. Methods: Twenty-seven male domestic swine weighing (32.7±3.8)kg were utilized. After 40% of estimated blood volume was removed within 20 minutes, the animals were subjected to 5 minutes of untreated ventricular fibrillation and then 5 minutes of cardiopulmonary resuscitation. Additionally, fluid resuscitation was initiated coincident with the beginning of cardiopulmonary resuscitation. The animals were randomly divided into model group (n=12) and ABO group (n=15). Once cardiopulmonary resuscitation was implemented, aortic balloon was concurrently inflated to stop the blood flow of descending thoracic aorta at the level of the diaphragm in the ABO group. In the model group, aortic balloon was placed in the same position without inflation. During cardiopulmonary resuscitation, the changes of coronary perfusion pressure (CPP), forehead's regional cerebral oxygen saturation (rSO₂) and pressure of end-tidal CO₂ (PETCO₂) were continuously monitored, and the rate of return of spontaneous circulation (ROSC), duration of cardiopulmonary resuscitation, number of shocks and dose of epinephrine were recorded. At 5 minutes after successful resuscitation, the levels of arterial blood gas, lactate and jugular venous blood oxygen saturation (SjvO₂) were measured. Results: Compared with the model group, the values of CPP, rSO₂ and PETCO₂ during cardiopulmonary resuscitation were significantly increased in the ABO group [CPP: (33.5±5.6)mmHg vs. (23.1±5.2)mmHg at 1 minute, (35.3±6.0)mmHg vs. (26.8±7.4)mmHg at 2 minutes, (36.3±6.3)mmHg vs. (28.2±6.3)mmHg at 3 minutes, (40.1±7.1)mmHg vs. (30.5±6.2)mmHg at 4 minutes, (38.1±7.5)mmHg vs. (29.8±5.3)mmHg at 5 minutes; rSO₂: (45.4±5.2)% vs. (39.2±5.1)% at 1 minute, (47.2±3.6)% vs. (42.0±6.4)% at 2 minutes, (47.7±3.0)% vs. (41.5±5.4)% at 3 minutes, (47.0±2.5)% vs. (42.1±5.9)% at 4 minutes, (47.1±2.0)% vs. (41.5±7.4)% at 5 minutes; PETCO₂: (17.0±3.5)mmHg vs. (12.7±4.2)mmHg at 1 minute, (18.5±3.7)mmHg vs. (14.5±2.7)mmHg at 2 minutes, (20.7±5.3)mmHg vs. (15.5±3.2)mmHg at 3 minutes, (18.7±4.5)mmHg vs. (14.9±3.5)mmHg at 4 minutes, (18.2±3.2)mmHg vs. (14.5±4.2)mmHg at 5 minutes] (all P<0.05). The rate of ROSC was significantly higher in the ABO group than in the model group[100%(15/15) vs. 75%(9/12)] (P<0.05). Additionally, shorter duration of cardiopulmonary resuscitation, less number of shocks and lower doses of epinephrine were observed in the ABO group when compared with the model group[duration of cardiopulmonary resuscitation: 5(5, 5)minutes vs. 5(5, 12.5)minutes, number of shocks: 1(1, 1)times vs. 1(1, 4)times, dose of epinephrine: 0.62(0.62, 0.74)mg vs. 0.64(0.59, 2.59)mg] (all P<0.05). At 5 minutes after resuscitation, the level of arterial lactate was significantly decreased and the value of SjvO₂ was significantly increased in the ABO group compared with the model group[Lactate: (9.6±0.8)mmol/L vs. (10.8±1.4)mmol/L; SjvO₂: (50.0±8.6)% vs. (37.9±16.3)%] (both P<0.05). Conclusions In a swine model of TCA, ABO can increase cardiac and cerebral perfusion during cardiopulmonary resuscitation and improve the efficacy of cardiopulmonary resuscitation. It might provide a novel and effective method for the resuscitation of TCA in the clinical setting.

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.
Abdomen ; surgery ; China ; Drainage ; methods ; Evidence-Based Medicine ; Humans ; Practice Guidelines as Topic ; Societies, Medical ; organization & administration ; Surgical Wound Infection ; prevention & control ; Traumatology ; organization & administration ; Vacuum

The well-known insulin-like growth factor 1 (IGF1)/IGF-1 receptor (IGF-1R) signaling pathway is overexpressed in many tumors, and is thus an attractive target for cancer treatment. However, results have often been disappointing due to crosstalk with other signals. Here, we report that IGF-1R signaling stimulates the growth of hepatocellular carcinoma (HCC) cells through the translocation of IGF-1R into the ER to enhance sarco-endoplasmic reticulum calcium ATPase 2 (SERCA2) activity. In response to ligand binding, IGF-1Rβ is translocated into the ER by β-arrestin2 (β-arr2). Mass spectrometry analysis identified SERCA2 as a target of ER IGF-1Rβ. SERCA2 activity is heavily dependent on the increase in ER IGF-1Rβ levels. ER IGF-1Rβ phosphorylates SERCA2 on Tyr⁹⁹⁰ to enhance its activity. Mutation of SERCA2-Tyr⁹⁹⁰ disrupted the interaction of ER IGF-1Rβ with SERCA2, and therefore ER IGF-1Rβ failed to promote SERCA2 activity. The enhancement of SERCA2 activity triggered Ca²⁺_ER perturbation, leading to an increase in autophagy. Thapsigargin blocked the interaction between SERCA2 and ER IGF-1Rβ and therefore SERCA2 activity, resulting in inhibition of HCC growth. In conclusion, the translocation of IGF-1R into the ER triggers Ca²⁺_ER perturbation by enhancing SERCA2 activity through phosphorylating Tyr⁹⁹⁰ in HCC.