ObjectiveTo evaluate the effects of ventilator circuit change frequency on ventilatorassociated pneumonia (VAP).MethodsMeta-analysis of effects of ventilator circuit change frequency on VAP was conducted with study-level data from 1995 to 2010 in Pubmed,Embase,Web of Science databases.ResultsNine articles were included (sample size:20 326 mechanically ventilated patients).Analysis of six articles showed that the incidence of VAP in ventilator circuit change every 2 or 3 days was 4.05％,while 3.65％ in ventilator circuit change every 7 days.Compared with change ventilator circuit every 2 or 3 days,the risk ratio (RR) of VAP in weekly changes was 0.77 [0.54,1.09] ( P =0.14 ).Analysis three articles showed that compared to ventilator circuit change every 7 days with 15.89％ incidence of VAP,the incidence of VAP in circuit change more than 14 days was 14.9％,and RR was 0.98 [0.69,1.39](P =0.91 ).ConclusionsRegular ventilator circuit change frequency in various intervals can't difference in the incidence of VAP in mechanical ventilation patients.

Objective To study the positive end-expiratory pressure (PEEP) adjustment after recruitment maneuver during acute respiratory distress syndrome (ARDS) especially in the presence of tonic diaphragm electrical activity (Tonic EAdi) in order to obtain optimum PEEP and in turn to get successful oxygenation.Methods Rabbit model of ARDS was nade by intratracheal instillation of hydrochloric acid.After sufficient recruitment maneuvers,the rabbits were randomly (random number) divided into two groups,namely Tonic EAdi group ( n =5 ) and maximum oxygenation group ( n =5 ).In Tonic EAdi group,the regulation of PEEP was guided by Tonic EAdi.In maximum oxygenation group,PEEP was adjusted as per maximum oxygenation.The differences in magnitude of PEEP,pulmonary mechanics,gas exchange and hemodynamics were compared between two groups.The t-test was used to compare continuous variables between the two independent samples,and the difference was statistically significant when P ＜ 0.05.Results (1) PEEP:The PEEP was (10.7 + 1.4) cmH2O (1 cm H2O=0.098 kPa) in Tonic EAdi group and (10.0 ± 2.8) cm H2O in maximum oxygenation group (P ＞ 0.05). (2) Pulmonary mechanics:After PEEP adjustment,there was no significant difference in tidal volume ( Vr),peak pressure (Ppeak) and mean pressure (Pmean) between the two groups (P ＞ 0.05 ).(3) Gas exchange:After PEEP adjustment,there was no significant difference in oxygenation index (PaO2/FiO2) and partial pressure of arterial carbon dioxide ( PaCO2 ) between the two groups (P ＞ 0.05).Conclusions Tonic EAdi could be a good indicator for regulating PEEP in ARDS.

Objective To observe the effects of recruitment maneuver (RM) and tidal volume with different amount of gas after RM ventilation on lung diastole function in rats with acute lung injury (ALI). Method ALI rat models were induced by intravenous infusion of lipopolysaccharide (LPS) in dose of 6 mg/kg. Twenty-five rats were randomly(random number) divided into control group ( n = 5), ALI group ( n = 5), low tidal volume group (LV group,VT= 6 mL/kg, n = 5), sustained inflation (SI) with low tidal volume (SI+ LV group, VT=6 mL/kg, n = 5), and SI with moderate tidal volume group (SI+ MV group, VT= 12 mL/kg, n = 5). The RM carried out by using SI with airway pressure 30 cmH-2O for 30 seconds, and the positive end-expiratory pressure (PEEP)was set at 5 cmH2O. Lung tissue was taken after mechanical ventilation for 5 hours. The mean arterial pressure (MAP) was monitored throughout the entire course of experiment. Endothelin-1 ( ET-1 ), endothelial nitricoxide synthase (eNOS), and acetylcholine-(Ach-) induced endothelium-dependent relaxation response of isolated pulmonary artery rings were investigated after mechanical ventilation for 5 hours. Results The LPS increased the ET-1 level in lung tissue, decreased the level of eNOS in lung tissue, and impaired the Ach-induced endothelium-dependent relaxation response in pulmonary vassals, without obvious influence on systemic hemodynamics. SI + LV significantly reduced LPS-induced elevation of ET-1 level, and increased the level of eNOS, and significantly lessened endothelial dysfunction and ameliorated dysfunction od endothelium-dependent relaxation in pulmonary vas sals. Conclusions RM with high tidal volume or lowtidal volume ventilation could improve the lung vascular endothelial function of rats with acute lung injury, and RM with low tidal volume ventilation could lessen more the injury of lung vascular endothelial diastole function in rats with acute lung injury.

Objective To investigate the effects of elasticity resistance (Ers) in respiratory system on oxygenation in patients with acute lung injury (ALI) after recruitment maneuvers (RM). Method Meta-analysis of data about the effects of recruitment maneuvers on oxygenation in ALI patients with different elasticity resistances in respiratory system carried out with pooling of study-oriented data stored in Pubmed, Embase, Web of Science databases from January 1999 to June 2010. Results A total of 281 articles were taken, and 20 of them included a sample size of 395 ALI patients. In patients treated with RM in different degrees of respiratory system elasticity resistance ( ≥33.3 cmH2O/L and ＜33.3 cmH2O/L), the effect of RM was better in patients with the high respiratory system elasticity resistance than that with the low one [(51.97 + 8.89) mmHg vs. (35.13 ± 10.33 ) mmHg], P ＜ 0. 01 ), but the high respiratory system elasticity resistance was potentially to lower blood pressure [(4. 33 ± 1.32 ) mmHg vs. (0.22 ± 1.03 ) mmHg],P ＜ 0.01 ). Conclusions This study suggests RM could improve oxygenation of ALI patients with high respiratory system elasticity resistance, and caution must be made to avoid hypotension during RM.

BACKGROUND: This study aimed to observe the effect of recruitment maneuver (RM) and post-RM ventilation at different tidal volume on lung vascular diastole endothelial function in rats with acute lung injury (ALI). METHODS: A ALI rat model was produced by intravenous infusion of lipopolysaccharide (6 mg/kg). Twenty-five rats were randomly divided into five groups: control group (n=5), ALI group (n=5), low tidal volume group (LV group, VT 6 mL/kg, n=5), sustained inflation (SI) with low tidal volume group (SI+LV group, VT 6 mL/kg, n=5), and SI with moderate tidal volume group (SI+MV group, VT 12 mL/kg, n=5). RM was performed with SI, airway pressure 30 cmH2O for 30 seconds, and positive end-expiratory pressure (PEEP) was set to 5 cmH2O. Lung tissue was taken after 5 hours of mechanical ventilation. Mean arterial blood pressure (MAP) was monitored during the experiment. Endothelin-1 (ET-1), endothelial nitricoxide synthase (eNOS), Ach-induced endothelium-dependent relaxation response of isolated pulmonary artery rings were determined at 5 hours. RESULTS: LPS increased ET-1 level, decreased the expression of eNOS in lung tissue, impaired the Ach-induced endothelium-dependent relaxation response in the pulmonary artery, without obvious effect on systemic hemodynamics. SI+LV significantly reduced LPS-induced elevation of ET-1 level, increased the expression of eNOS, significantly improved endothelial dysfunction, and improved the dysfunction of endothelium-dependent relaxation in the pulmonary artery. CONCLUSIONS: RM with a high or low tidal volume ventilation could improve the lung vascular endothelial function of rats with acute lung injury, and RM with low tidal volume ventilation could lower significantly the injury of lung vascular endothelial diastole function in rats with acute lung injury.

OBJECTIVETo evaluate the surgical techniques for acute left deep venous thrombosis (LDVT) secondary to left iliac vein compression syndrome (IVCS).

METHODSThirty-six patients with acute LDVT secondary to IVCS received inferior vena cava filter placement, and in 2 of the cases, stent implantation was canceled for acute episode of obsolete DVT. The remaining 34 patients underwent left femoral venotomy for iliofemoral thrombectomy with Fogarty catheter and distal femoral vein thrombus removal by sequential compression of the legs, followed by implantation of stent-graft (2 cases) or bare-metal stents (32 cases) in the left common iliac veins. With routine anticoagulation and thrombolytic treatments, the patients were regularly examined for postoperative blood flow in the affected limb.

RESULTSIn 2 of the cases undergoing bare-metal stent implantation, the residue thrombi were squeezed into the stent by balloon, which was managed subsequently with local thrombolysis. One patient with bare-metal stent implantation received a secondary stenting for posterior stent displacement. Three patients had self-limited bleeding due to decreased serum FBG. Significant improvements were achieved at 3, 6, 30 and 180 days postoperatively in the circumferences of the affected limb (P<0.05) and in the levels of D-dimer (P=0.011), and FBG level showed no significant variations (F=1.163, P=0.345). The total rate of excellent outcomes was 83.3% (26/34) with a total effective rate of 91.2% (31/34) in these cases.

CONCLUSIONSThrombectomy to revascularize the inflow tract and stent implantation to enlarge stenosed iliac veins are key issues in treatment of acute LDVT secondary to IVCS.

Femoral Vein ; surgery ; Humans ; Leg ; pathology ; May-Thurner Syndrome ; complications ; surgery ; Stents ; Thrombectomy ; Vascular Grafting ; Venous Thrombosis ; etiology ; surgery

OBJECTIVETo study the application of intraoperative irrigation of the colon in primary resection and anastomosis of left colorectal cancer with intestinal obstruction.

METHODSThe clinical data were analyzed in 58 patients with left colon rectal cancer and intestinal obstruction undergoing intraoperative irrigation of the colon for primary anastomosis, and the results were compared with 58 patients receiving conventional primary tumor resection.

RESULTSThe mean intraoperative blood loss or postoperative hospital stay was comparable between the two groups, but the patients undergoing colon irrigation had significantly delays in the recovery of bowel movement.

CONCLUSIONWith strict control of the surgery indication, intraoperative colon irrigation can be safe and feasible in primary resection and anastomosis of left colorectal cancer with intestinal obstruction.

Adult ; Anastomosis, Surgical ; methods ; Colon ; Colorectal Neoplasms ; complications ; surgery ; Female ; Humans ; Intestinal Obstruction ; etiology ; surgery ; Intraoperative Period ; Male ; Middle Aged ; Therapeutic Irrigation ; methods

OBJECTIVETo investigate the clinical value of local regional administration of urokinase and argatroban through small saphenous vein (SSV) catheter in the treatment of acute deep venous thrombosis in the lower limb (LDVT).

METHODSFifty-six patients with acute LDVT were prospectively randomized into the study group (21 cases, 24 limbs) and control group (35 cases, 36 limbs) for treatment with urokinase and argatroban regionally administered via the SSV catheter and with the same agents given via the peripheral vein, respectively. The patients were examined for changes in serum fibrinogen (FBG) and D-dimer and the perimeter of the affected limbs, and the complications in relation to the agents were observed.

RESULTSBy corrected Chi-square test, the incidence of complications was significantly lower in the study group than in the control group (1/21 vs 4/36, χ(2)=1.92, P≤0.05). Wilcoxon's sign rank test suggested no statistically significant difference between the two groups in the total effective rate (95.8% vs 94.4%, V=0.52, P>0.05), but the total excellent rate differed significantly between them (83.3% vs 55.6%, V=2.36, P≤0.05). Serum FBG underwent no significant variations in the study group during thrombolysis (P>0.05), but decreased significantly in the control group (P≤0.05). The decreases in serum D-dimer and perimeter of the affected limbs occurred earlier in the study group than in the control group (P≤0.05).

CONCLUSIONRegional administration of urokinase and argatroban via small saphenous vein catheter can promote the thrombolytic effect and reduce the risk of hemorrhage in the treatment of LDVT.

Adult ; Female ; Fibrinolytic Agents ; Humans ; Injections, Intravenous ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Pipecolic Acids ; administration & dosage ; therapeutic use ; Saphenous Vein ; Urokinase-Type Plasminogen Activator ; administration & dosage ; therapeutic use ; Venous Thrombosis ; drug therapy ; Young Adult

OBJECTIVETo explore the relationship between hypoxia-inducible factor-1α (HIF-1α) mRNA levels in the peripheral blood and the metastasis of colorectal cancer.

METHODSHIF-1α mRNA in the peripheral blood was detected by RT-PCR in 40 patients with colorectal cancer and 20 healthy subjects.

RESULTSSeventeen patients with colorectal cancer showed positivity for HIF-1α mRNA, showing a significantly higher positivity rate (42.5%) than the healthy subjects (P<0.05). The expression of HIF-1α mRNA is closely related to the staging of colorectal cancer (CRC).

CONCLUSIONHIF-1α mRNA may serve as a potential marker in the detection of metastasis of colorectal cancer.

Adenocarcinoma ; blood ; pathology ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colorectal Neoplasms ; blood ; pathology ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; blood ; genetics ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Metastasis ; RNA, Messenger ; genetics

OBJECTIVETo observe epithelial-mesenchymal phenotypes and oxidative stress related protein expressions of the liver cells in a rat model of liver fibrosis induced by bile duct ligation and recanalization.

METHODSTwenty-four male Wistar rats were randomized into 4 groups, including a sham-operated group, two bile duct ligation groups with ligation for 2 and 4 weeks, and a bile duct ligation group with a 2-week ligation followed by a 2-week recanalization. HE staining and Masson staining were used to assess liver fibrosis in the rats, and immunohistochemistry and Western blotting were employed to detect expressions of the epithelial and mesenchymal marker proteins and oxidative stress-related proteins.

RESULTSCompared with the sham-operated group, the rats with bile duct ligation showed obvious liver fibrosis, which worsened as the ligation time extended, accompanied by significantly increased expression of α-SMA, collagen I, NOX(4) and vimetin and reduced E-cadherin expression. Compared with the rats with bile duct ligation for 4 weeks, the rats in bile duct ligation-recanalization group showed obviously lessened liver fibrosis, significantly lowered expressions of NOX(4) and mesenchymal cell maker proteins, and enhanced expressions of epithelial cell marker proteins.

CONCLUSIONBile duct ligation up-regulates mesenchymal phenotype-related proteins and NOX(4) protein expression and down-regulates the expression of epithelial phenotype-related proteins, and these changes can be reversed by subsequent bile duct recanalization.

Actins ; metabolism ; Animals ; Bile Ducts ; surgery ; Cadherins ; metabolism ; Collagen Type I ; metabolism ; Disease Models, Animal ; Epithelial Cells ; cytology ; metabolism ; Hepatocytes ; cytology ; metabolism ; Ligation ; Liver Cirrhosis ; metabolism ; Male ; NADPH Oxidase 4 ; NADPH Oxidases ; metabolism ; Oxidative Stress ; Phenotype ; Rats ; Rats, Wistar ; Vimentin ; metabolism