10.3969/j.issn.2095-4344.2013.26.025

Objective To evaluate the tissue response to the covered metallic stent loaded with radioactive 125I seeds in normal rabbit esophagus.Methods Twelve rabbits were randomlv assigncd into 2 groups.A covered metallic stent loaded with three 125I seeds set in sheaths Was implanted into the esophagus of the rabbit from experimental group(22.2 MBq for each seed,n=6).The rabbits of control group were implanted with stent without 125I (n=6).Two rabbits from each group underwent esophagus X-ray examination to detect migration of the stent and the 125I seeds at 2,4 and 8 weeks after stent implantation,respectively.And the animals were then sacrificed to observe the changes in esophagus.Results No 125I seed migration Was found during and after the implantation of the stent.No esophageal perforation was observed.Two weeks after stent implantation,such mild lesions were observed in the middle of the esophagus in experimental group as slight epithelial hyperplasia and submucosal inflammation.At 4th week after stentimplantation,granulation and fibrosis were observed,which became more obvious at 8th week after the procedure.The injury of esophageal tissue opposite to the 125I seed Was significantly milder than that of the tissue exposed to 125I seed.In control group,esophagus adjacent to the middle of the stent WaS similar to normal tissue,with slight epithelial hyperplasia.However,both ends of the stent were covered with marked hyperplasia epithelium in both groups,and severe granulation and fibrosis could be observed.Conclusion The main pathological changes of esophagus wall adjacent to the 125I seed are granulation and fibrosis.No bleeding or perforation occurs.

Adult ; Aged ; Female ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Tracheotomy ; adverse effects ; Young Adult

ObjectiveTo investigate the effect of interstitial brachytherapy with 125Ⅰon human esophageal carcinoma implanted in nude mice. MethodsAnimal model simulating human esophageal carcinoma was established by subcutaneous implantation of cultured Eca-109 cell lines into nude mice.The mice were randomly divided into 3 groups,namely control group (saline plus empty seed),125Ⅰ seed group (22.2 MBq×1 seed),and DDP group (cisplatin at the dose of 1 mg/kg),to receive corresponding treatment.The growth rate and the pathological changes of esophageal carcinoma were observed.ResultsThe animals were sacrificed 16 days after irradiation.The average tumor weight in control group,125Ⅰ seed group,and DDP group were (0.20±0.06) g, (0.12±0.03) g and (0.12±0.05 ) g,respectively (P<0.05).Pathological findings included degeneration and necrosis of the tumor cells.Compared to the control group,the necrosis areas in 125Ⅰ seed group and DDP group were significantly larger than those in control (P<0.05).Conclusion125Ⅰ seed brachytherapy in esophageal carcinoma could cause degeneration and necrosis of the tumor cells and had inhibitory effect on tumor growth.

BACKGROUND: With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia (VAP) has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children. METHODS: From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children's Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS: A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli (G-) were the most (65.55％), followed by fungi (21.01％) and gram-positive cocci (G+, 13.45％). Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G+ to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G+ to vancomycin, teicoplanin and linezolid were 100％. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION: In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

BACKGROUND: With beta-lactam drugs and immunosuppressants widely used, the infection caused byAcinetobacter baumannii (Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii (MDRAb) emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. METHODS: A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb (NMDRAb) pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children's Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. RESULTS: In 176 clinical strains ofAcinetobacter baumannii isolated, there were 128 strains of MDRAb, accounting for 72.73％. Drug susceptibility tests showed that the resistance rates of β-lactam antibiotics were more than 70％ except for cefoperazone sulbactam. The rates to carbapenems were higher than 90％. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates (<20％). Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. CONCLUSIONS: MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

OBJECTIVETo explore the correlation between Pi and Shen by observing the relationship between the metabolism of aristolochic acid (AA) and mRNA and protein expression levels of organic anion transporting polypeptide (oatp) superfamily member 2a1 and 2 b1 (oatp2al and oatp2bl) in renal, small intestinal, and large intestinal tissues of Pi deficiency syndrome (PDS) model rats.

METHODSTotally 46 Sprague-Dawley (SD) rats were randomly divided into four groups, i.e., the blank group (n = 12), the PDS group (n = 22), the AA-I group (n = 6), and the PDS AA-I group (n = 6). PDS model was established by subcutaneously injecting Reserpine at the daily dose of 5 mg/kg for 16 successive days. Carotid intubation was performed in 6 rats selected from the blank group and the PDS group. Pharmacokinetics of AA-I were detected at 5, 15, 30, 45, and 60 min after gastrogavage of AA-I. AA-I concentrations in renal, small intestinal, and large intestinal tissues of 10 rats selected from the PDS group were determined. Normal saline was administered to 6 rats selected from the PDS group and the blank group by gastrogavage. Renal, small intestinal, and large intestinal tissues were collected in the AA-I group and the PDS AA-I group at 60 min after gastrogavage of AA-I. mRNA and protein expression levels of oatp2a1 and oatp2b1 in each tissue were detected using real-time polymerase chain reaction (RT- PCR) and Western blot.

RESULTSCompared with the blank group, plasma concentrations of in vivo AA-I were obviously higher in the PDS group at 15, 30, 45, and 60 min after gastrogavage of AA-I with statistical difference (P < 0.05). Plasma concentrations of AA-I were obviously decreased at 60 min after gastrogavage of AA-I; AA-I concentrations in renal and large intestinal tissues were elevated; AA-I concentrations in small intestinal tissues were obviously reduced in the PDS group. There was no statistical difference in mRNA expression levels of oatp2a1 and oatp2b1 in the aforesaid three tissues of rats between the blank group and the PDS group. Compared with the blank group, mRNA expression levels of oatp2a1 and oatp2b1 decreased in small intestinal tissues of the AA-I group, and the mRNA expression level of oatp2a1 in large intestinal tissues significantly decreased (P < 0.05, P < 0.01). Compared with the PDS group, mRNA expression levels of oatp2a1 and oatp2b1 increased in renal tissues of the PDS AA-I group (P < 0.05); mRNA expression levels of oatp2b1 increased in large intestinal tissues of the PDS AA-I group (P < 0.05).

CONCLUSIONSThe difference in AA-I metabolism might be associated with changed expression levels of oatp2a1 and oatp2b1 in renal, small intestinal, and large intestinal tissues under Pi deficiency induced loss of transportation. Shen and Dachang played important roles in substance metabolism under Pi deficiency state, which proved Pi-Shen correlated in Chinese medical theories.

Animals ; Anions ; Aristolochic Acids ; metabolism ; Drugs, Chinese Herbal ; Kidney ; Medicine, Chinese Traditional ; Organic Cation Transport Proteins ; metabolism ; Peptides ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley

Objective To analyze the relevance between blood lactic acid level and acutephysiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score in order to provide guideline for clinical treatment.Methods Retrospective analyses on 537 critically ill elderly patients who were hospitalized in the ICU with their blood lactic acid level tested and APACHE Ⅱ scores calculated.Results The overall death rate was 35.75％ (192/537) with the APACHE Ⅱ score as (22.6 ± 12.8),and blood lactic acid level as (6.84 ± 2.01 ) mmol/L.The blood lactic acid level among deaths was obviously higher than in the control group,with significant differences (P＜0.05).The level of blood lactic acid was positively related to APACHE Ⅱ score (r=0.572,P＜0.05) while the death rate was both positively related to APACHE Ⅱ score (r=0.475,P＜0.05) and the level of blood lactic acid (r=0.506,P＜0.05).Conclusion There seemed a positive correlation between blood lactic acid level and the APACHE Ⅱscore.Both of them showed good relevancc with thc prognosis of the disease.

Objective To investigate the management of pregnancy and cardiovascular complications in women with Marian syndrome(MFS).Methods From October 1994 to September 2006, 30 patients with MFS undergoing cardiovascular surgery were studied retrospectively.Results In the labor of 46 offsprings given birth by 30 women,5 cases(11%)were performed elective cesarean section because of the existence of aortic complication,and 12(26%)were diagnosed as MFS.The gestation in two patients was terminated due to deterioration of aortic abnormalities during their third trimester,and they received surgical treatment with Bcntall procedure.Two developed acute aortic dissection during labor and post delivery respectively.With the manipulation of anticoagulation peripartum,one who had the implantation with mechanical prosthesis went through pregnancy and delivery uneventfully.The average duration between delivery and cardiovascular surgery was(15?9)years.Conclusions Vaginal delivery can be done safely in patients with the MFS who do not have or have mild cardiovascular system abnormalities,aortic dissection,or other important cardiac abnormalities,cesarean section should be the preferred method of delivery.Women with MFS are at increased risk for dissection and congestive heart failure during pregnancy and should be counseled before pregnancy about these risks,as well as the inheritance of the condition.

Objective To explore the endoscopic and clinicopathological characteristics of upper gastrointestinal tract metastasis,it can improve the diagnosibility of endoscopists and pathologists. Methods Three cases of upper gastrointestinal tract metastasis and seven cases in the related literature were studied, and its endoscopy and clinicopathological findings were analyzed with a review of the literature, whose gastrointestinal symptoms were the first manifestation. Results Case 1 endoscopic detection of esophageal ulcer lesions, pathological diagnosis of metastatic cancer, considering the source of the lung, confirmed by imaging examination; Case 2 showed that the gastric body was prominent, and the pathological diagnosis was squamous cell carcinoma. It was suggested that the clinical examination should be carried out without metastasis, and then confirmed by imaging examination and bronchoscopy biopsy; Case 3 endoscopic examination revealed multiple polypoid lesions in the stomach and duodenum, and was pathologically diagnosed as metastatic renal cell carcinoma. 3 patients were correctly diagnosed, thus avoiding unnecessary radical surgical treatment. 7 cases of patients in the literature were aged, they were also in a variety of gastrointestinal symptoms and the first diagnosis, no previous history of cancer, endoscopic lesions in the stomach or duodenum, supplemented by immunohistochemical staining in pathological diagnosis were diagnosed as metastases, the primary tumor site without organ specific. Conclusion The metastasis of upper gastrointestinal tract is rare, especially when the gastrointestinal symptoms were the first manifestation,it is usually missed and misdiagnosed. The diagnosis relies on the endoscopic and pathological examination, supplemented by the imaging examination, so the patients could get effective treatment in time.