Objective To observe influence of auxiliary treatment of bronchoscopy alveolar lavage on respira-tory mechanics index and infection control effect in patients with severe ventilator associated pneumonia(VAP). Methods 84 cases of severe VAP patients were randomly divided into the observation group (n =42 cases)and con-trol group (n =42 cases),control group was given antibiotics and conventional sputum suction lavage treatment,the observation group was given bronchoscopy alveolar lavage and antibiotics.Clinical pulmonary infection score (CPIS) and serum calcitonin level (PTC)were recorded in the two groups before and after treatment.Respiratory mechanics indexes such as the dynamic compliance (Cdyn),the airway peak pressure (PIP),work of breathing (WOB)and airway resistance (Raw)were measured in the two groups before and after bronchoscopy alveolar lavage,and the clin-ical efficacy of two groups were compared.Results CPIS of the observation group (6.37 ±1.31),(5.42 ±1.13), (3.52 ±0.53)was significantly lower than that of the control group (7.72 ±1.56),(7.14 ±1.33),(5.13 ± 0.94)(t =4.295,6.387,5.821,all P <0.05 )after 3,5,7d treatment.PTC of the observation group ((4.71 ± 0.85)μg/L,(2.65 ±0.61 )μg/L,(0.62 ±0.23)μg/L)were significantly lower than those of the control group (5.10 ±0.92)μg/L,(3.96 ±0.72)μg/L,(1.31 ±0.43)μg/L(t =4.295,6.387,5.821,all P <0.05)after 3,5, 7d treatment.Cdyn of the observation group after 1 and 4h bronchoscopy alveolar lavage (35.39 ±6.39),(35.59 ±5.83)were high those of the control group (26.82 ±4.63),(25.64 ±4.28)(t =7.038,-10.462,all P <0.05);WOB (10.08 ±0.45),(8.10 ±0.38),PIP(21.28 ±2.76),(15.29 ±1.67)and Raw (10.08 ±0.45),(8.10 ± 0.38)in the observation group after 1and 4h bronchoscopy alveolar lavage were lower those in the control group WOB (0.63 ±0.17),(0.49 ±0.12),Raw(13.49 ±0.50),(11.42 ±0.42),PIP(27.38 ±3.10),(23.44 ±2.60)(1h:t =9.681,3.937,32.853,all P <0.05;4h:t =12.231,6.064,6.313,all P <0.05).Total effective rate of the obser-vation group was obviously higher than that of the control group after treatment (93.3% vs.77.8%,chi -square =5.486,P <0.05).Conclusion Auxiliary treatment of bronchoscopy alveolar lavage has clinical curative effect in patients with severe VAP,the method can effectively decreased PTC level of VAP patients,to acquire lung infection control,and improve the respiratory mechanics parameters.

Objective To study the clinicopathologic characteristics and the prognostic factors of gastric stump cancer (GSC). Methods A total of forty-seven patients with GSC from Jan 2000 to Dec 2006 were enrolled in this study for retrospective analysis. Initial surgery was performed for gastric benign disease in 39 patients and for malignant disease in 8 patients, which were divided into 2 groups for analysis. The prognosis of all 47 patients were analyzed. Results The mean interval between previous gastrectomy and diagnosis of GSC was 24.4 years. Tumor developed mostly in the patients with Billroth- Ⅱ reconstruction, and male more than female. Tumor located at anastomotic site mostly, at stump stomach and cardia secondly. The mean interval for patients who had undergone their first gastrectomy for malignant disease was shorter than that with benign disease(P＜0.05). Histology, therapy and prognosis showed no significant differences between two groups (P＞0.05). Disease TNM stage and total radical gastrectomy were shown to be significant predictor for the outcome of patients with GSC (P ＜0.01). Conclusion Now the GSC patients with initial surgery performed for malignant disease are increased, which are no siginificant different to patients with benign disease. Early diagnosis and an aggressive surgical approach are crucial to achieve better outcomes for patients with GSC.

Objective To investigate the effects of rehabilitation training on the microenvironment for axon regeneration and the possible mechanisms promoting axon regeneration,reconstruction and functional compensation after spinal cord injury (SCI) in beagle dogs.Methods Fifteen beagles were divided into a sham operated group,an SCI model group and a rehabilitation training group.Spinal cord hemi-transection injury was carried out.From the 8th day after SCI,the rehabilitation training group was given treadmill training.All dogs were sacrificed 60 days postinjury and samples were harvested.Chondroitin sulphate proteoglycan (CSPG) expression of astroglial cells around the injured area was observed using an immunofluorescence technique.The expression of glial fibrillary acidic protein (GFAP) and CSPG protein in each group were semi-quantified by Western blot analysis.Axon regeneration was observed by silver staining.Motor function was assessed using modified Tarlov scores.Results In the rehabilitation training group,compared with the model group astroglial production of CSPG was reduced remarkably.Both CSPG expression and axon regeneration were enhanced and functional deficits improved.Conclusions Rehabilitation training can inhibit astroglial production of CSPG,improve the microenvironment for injured axon regeneration,and promote reconstruction and functional compensation after traumatic SCI.

Objective To investigate mobilization of the bone-marrow-derived stem cell (BMSC) into peripheral blood by granulocyte-colony stimulating factor (G-CSF) to accelerate the renal regeneration.Methods Six-week-old transgenic C57BL/6J mice labeled with green fluorescent protein (GFP) as bone marrow donors and C57BL/6 mice without fluorescence label as recipients ( n =20 ) of bone marrow transplantation were used.All recipients received lethal dose of 8.5 Gy total body γ-ray irradiation with 137 Cs before bone marrow transplantation,and the transplantation of bone marrow mononuclear cells 2 × 105 by retrobulbar injection was done two hours later after irradiation. Bone marrow reconstruction after transplantation was proved by flow cytometry five weeks after transplantation.Six weeks after the bone marrow reconstruction completed,left renal pedicles of all mice were cross-clasped for 30 minutes followed by reperfusion to establish the animal model of ischemia-reperfusion injury.Mice were divided into two groups:( 1 ) Saline control group ( n =10),saline 0.2 ml/day was injected subcutaneously into chimeric mice from 3 days before to 4 days after operation ; (2) G-CSF mobilization group (n =10),chimeric mice were injected subcutanously with recombinant human G-CSF,200μg/kg/day,once a day from three days before surgery for a week.On the 1st day after mobilization,the percentage of stem cell in non-erythroid cells of peripheral blood was detected by using flow cytometry.One week after ischemia,the homing of BMSC to kidney was identified by flow cytometory.Renal tissue sections were stained with Hemotoxylin and Eosin staining method for pathological study,and the degree of renal tubular injury was analyzed by semiquantitative method of Vyacheslav.Four weeks after ischemia,the differences in degree of renal regeneration between the two groups by analysis the numbers of vascular endothelial cells in the kidney.Results After G-CSF mobilization,the percentage of stem cells with Sca-1 +,c-Kit +,CD29 and CD34 + antigen in peripheral blood in G-CSF mobilization group were higher than those in control group.One week after ischemia,mice of mobilization group showed higher percentage of Sca-1 +,c-Kit + and CD34 + bone marrow derived stem cells in tbe kidney compared to control group (P ＜0.05).One week after ischemia,the tubular epithelial damage score of mobilization group was lower significantly than that of the control group (P ＜ 0.05 ) studied by Hemotoxylin and Eosin staining. Four weeks after ischemia,mice of G-CSF mobilization group showed more CD31 positive cells in the kidney compared to control group (P ＜ 0.05 ).Conclusions G-CSF can effectively mediate the mobilization of bone marrow derived stem cells to peripheral blood and homing to kidney.G-CSF mobilization can accelerate renal regeneration and alleviate the degree of renal histopathological changes after ischemia.

Objective To evaluate the effectiveness of treating glioma in combination with drugs multiply by comparing the size of tumor and the survival time of different groups in rat glioma after targeted blood-brain barrier (BBB ) disruption by MRI-guided focused ultrasound.Methods The stereotaxis instruments and the 10 μl gas-tight syringes were used to inject gliosarcoma cells into the targeted area of the brain in 50 male Sprague-Dawley rats.The glioma-bearing rat model was established.Each rat received either:(1 )no treatment (control;n =8);(2)single liposomal doxorubicin (DOX;n = 10);(3)multiple DOX (n =10);(4)single Avastin (AVS)and DOX (n =10);(5)multiple AVS and DOX (n =10).The SonoVue microbubble ultrasonic contrast agent and DOX or AVS were injected into the tail vein respectively on day 12 after implantation.The tumor size was measured by MRI on pre-treatment,immediacy and once a week of post-treatment after targeted BBB disruption by focused ultrasound,and the life span in rat glioma was recorded.Results The mediam survival of different groups in rat glioma(The range of the life span 13-90 d):no treatment (7 d);single DOX (12 d);multiple DOX (1 5 d);single AVS + DOX (22 d), multiple AVS+ DOX (30 d).There was significant difference of the groups on mediam survival comparison (P < 0.01 ).The tumor growth pattern after post-treatment of different groups in rat glioma except control:single DOX was noticeable fast and multiple AVS+DOX was visibly delayed comparable to other groups,and finally the tumor size of multiple AVS + DOX even became small.Conclusions The microbubble blasting enhances the local tissue permeability and promotes the drug delivery of chemotherapy and anti-angiogenesis locally in glioma-bearing rats by MRI-guided focused ultrasound.Especially,the combination with drugs multiply has a synergism efficacy that may enhance the effectiveness of chemotherapy,reduce tumor growth,and even become small of the tumor size,and increase survival time significantly after BBB disruption.

OBJECTIVE: To reveal the characteristics of gene expression in adrenal gland of H22 tumor mice with typical syndromes and in different liver cancer stages. METHODS: By the quantitative four diagnosis and syndrome differentiation methods and GeneChip Mouse Exon 1.0 ST Array, we observed adrenal gland gene expression in H22 tumor mice with pathogenic factor-toxin predominance syndrome and qi deficiency syndrome in the earlier stage, yang-qi deficiency syndrome in the intermediate stage, and qi-yin-yang deficiency syndrome in the advanced stage. Genes highly expressed and remarkably different were analyzed in this study. RESULTS: A total of seventy-three up-regulated coincident genes and twenty-six down-regulated coincident genes in different stages were investigated in the study. Up-regulated coincident genes included Hp, C3, Anxa1, Procr, C2, Il4ra, Cd14, Ptprc, Cd52, C4b, Eno3, Xdh, Gpx3, and so on. Down-regulated coincident genes included nervous system function-related genes such as Plp1, Mbp, Aldh1a1, Cck, Atn1, genes associated with electrolyte metabolism such as Aldh1a1 and Slc22a17, genes related to signal transduction such as Cxcr4, Spag5 and Stmn3, etc, and genes related to transcriptional control and protein biosynthesis such as Hspa1a, Dnajb1, Thra, Hhex and so on. CONCLUSION: With the development of the tumorigenesis, the symptoms and signs and differentially expressed genes in adrenal gland of H22 tumor mice can be measured. Up-regulated and down-regulated coincident genes may be the features of H22 tumor mice different from those of normal mice.

Objective To analyze the level of post-traumatic stress disorder(PTSD)and its risk factors in patients with ischemic stroke.Methods A total of 183 cases of patients with ischemic stroke treated in Putuo District People's Hospital of Zhoushan City from May 2020 to June 2022 were selected as the observation objects.Basic information of patients was collected by self-made questionnaire,including gender,age,personality characteristics,family per capita monthly income,education level,marital status,ability of daily living,duration of ischemic stroke,family function,type of medical insurance,whether there was swallowing dysfunction,whether there was underlying disease(heart disease,hypertension,hyperlipidemia and diabetes),whether there is anxiety,coping style,level of social support.PTSD self-rating scale(PTSD-SS)was used to determine the complications of PTSD in ischemic stroke patients,and the incidence of PTSD was calculated.To compare the difference in basic information between the two groups of patients with PTSD.Factors with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to screen out the risk factors affecting the development of PTSD in patients with ischemic stroke,and receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the development of PTSD in patients with ischemic stroke.Results PTSD-SS score of 183 patients with ischemic stroke(48.76±9.21)was relatively low.Among them,37 case(20.22%)of patients developed PTSD.Compared with the non-PTSD group,the proportion of patients with introverted personality,dysfunctions of daily living,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support was significantly increased in the PTSD group(all P＜0.05).Multivariate Logistic regression analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support were independent risk factors for PTSD in ischemic stroke patients[odds ratio(OR)and 95%confidence interval(95%CI)were 2.289(1.091-4.804),5.842(1.658-20.587),2.634(1.095-6.333),7.138(3.255-15.655),2.751(1.271-5.953),3.153(1.477-6.733),all P＜0.05].ROC curve analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support all had certain predictive value for the occurrence of PTSD in ischemic stroke patients,the area under the ROC curve(AUC)was 0.602,0.675,0.573,0.722,0.603,0.624,and 95%CI was 1.091-4.804,1.342-9.566,1.095-6.333,3.255-15.655,1.271-5.953,1.477-6.733,respectively,all P＜0.05.The sensitivity to predict PTSD in ischemic stroke patients was 58.2%,87.7%,87.7%,79.5%,80.1%,78.8%,and the specificity was 37.8%,67.6%,70.3%,35.1%,59.5%,54.1%,respectively.Conclusions Ischemic stroke patients have a certain risk of concurrent stress disorder after trauma,and are easily affected by stroke patients'personality characteristics,daily living ability,swallowing dysfunction,coping style and social support,etc.Targeted preventive interventions should be developed to reduce the risk of PTSD and improve the prognosis and quality of life.

Objective:To explore the application value of the method of judging the density of small shadows in the lung area by using CT and CT reference films for pneumoconiosis.Methods:The chest imaging data of 244 employees of a large copper company in Tongling City, Anhui Province who underwent occupational physical examination at Tongling Municipal Hospital in Anhui Province from January 2016 to December 2019 were retrospectively analyzed. Totally 244 cases underwent chest CT scan and chest DR radiography at the same time. The shape and size of the small shadows (the size of the circular and quasi-circular nodules in the lung area were represented by p, q, r, and the size of the irregular small shadows were represented by s, t, u), the overall density, the density of small shadows in each lung area, the large shadows, and the diagnosis stage were observed and compared. The small shadow density of each lung area was judged by the method of judging the small shadow density of CT lung area and the reference film, and other observation indicators were judged according to GBZ70-2015 Diagnosis of Occupational Pneumoconiosis. Results:There was a significant difference between CT and DR in judging s-shaped small shadows and no small shadows ( P<0.05), and there was no statistically significant difference in judging p, q, r, t, and u-shaped small shadows ( P>0.05). CT and DR had medium to high consistency in the judgment of the overall density of small shadows (Kappa=0.692, P=0.001), and the diagnostic coincidence rate was 82.38% (201/244). There was moderate to high agreement between CT and DR in the density of small shadows shown in the right upper, right lower, left upper, left middle, and left lower lung regions (Kappa ranged from 0.40 to 0.75, P<0.05), and the consistency in the right middle lung region was poor (Kappa=0.381, P=0.001). Eleven large shadows were detected in 8 cases by DR, 31 large shadows were detected in 23 cases by CT, and 20 (8.20%) large shadows were detected more frequently by CT than DR. The agreement between CT and DR for the diagnosis and staging of silicosis was excellent (Kappa=0.843, P=0.001), and the diagnostic coincidence rate was 91.80% (224/244). Conclusion:Applying the method of determining the density of small shadows in the lung area of pneumoconiosis and reference films, combined with GBZ70-2015 Diagnosis of Occupational Pneumoconiosis, can make a more accurate diagnosis of silicosis.

OBJECTIVE: To present the experience of nasal reconstruction with forehead flap. METHOD: nasal reconstruction with forehead flap were applied in eight nasal carcinoma cases after operation and 5 nasal trauma cases with defects. RESULT: These forehead flaps were alive in all patients, all incision healed in I stage, no post operative complications were found. The shapes of nose were satisfactory, there were no recurrence of tumor during 1 to 17 year follow up. CONCLUSION The method can be clinically applied for its simple procedure, reliable flap's blood supply, high survival rate and satisfied result.
Adolescent ; Adult ; Aged ; Female ; Forehead ; surgery ; Humans ; Male ; Middle Aged ; Nose ; injuries ; surgery ; Rhinoplasty ; methods ; Skin Transplantation ; Surgical Flaps ; Young Adult

Osteoarthritis(OA)mainly lies in the lesions of articular cartilage and surrounding tissues,pro-ducing osteophytes and bone sclerosis,resulting in damage to the articular cartilage.The main pathological mechanism of OA rests with a large number of inflammatory cytokines and inflammatory mediators produced by joint synovial lesions as well as pathological vascular growth at the junction of the synovium and cartilage,which may be one of the key reasons for promoting synovitis and cartilage damage.The OA mainly occurs in the knees,hips,hands and the spine.It is mainly manifested by chronic joint pain,swelling and stiffness,and limitation of motion seriously affects the functional activities of patients.The treatment of OA mainly relies on oral administration or intraarticular injection of drugs to relieve symp-toms.When OA develops to the middle and late stages,the action and life of patients will be seriously affected.There-fore,surgical replacement of joints is considered to ensure the basic life demands of patients.Studies show that traditional Chinese medicine(TCM)treatment has attracted widespread attention and application due to its unique advantages in pre-vention and treatment of OA.Janus kinase(JAK)/signaling transduction and transcriptional activator(STAT)signaling pathway may be one of the important signaling pathways that regulate the chondrocyte proliferation,differentiation and apoptosis.Moreover,it is closely associated with intra-articular inflammatory response.The JAK/STAT signaling pathway regulates the expression of inflammatory factors and related proteins through TCM so as to reduce the inflammatory re-sponse and decrease the chondrocyte damage.It has an important reference value for OA treatment.In this paper,the roles and mechanisms of the TCM monomers and active ingredients and the Chinese herbal compounds in OA by regulating JAK/STAT signaling pathway and affecting related cytokine and protein expression levels have been reviewed,providing a new method and direction for TCM treatment of OA.