Objective The aim of this study was to determine the effects of ulinastatin, a broad spectrum proteinase inhibitor, on fibrinolytic system and platelet function during open heart surgery performed with cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅰ-Ⅱpatients of both sexes undergoing cardiac surgery under CPB were randomly divided into two groups of ten patients: control group(C) and ulinastatin group (U). In group U patients received ulinastatin 12 000 U?2kg-1 . Half of the dose was given iv 10 min before CPB and the other half was added to the priming solution. In group C patients received normal saline instead of ulinastatin. Blood samples were taken before CPB (T1 ) , 30 min after CPB was started (T2), at the end of CPB (T3), 2 h and 4 h after CPB(T4 , T5) for determination of plasma levels of D-Dimer, ?-granule membrane protein-140 (GMP-140), thromboxane B2 (TXB2) and 6-Keto-prostaglandin F1? (6-Keto-PGF1?) .Results The demographic data, aortic cross-clamping time, CPB time and duration of operation were comparable between the two groups. The plasma levels of D-Dimer, GMP-140, TXB2 and TXB2/6-Keto-PGFl? were significantly increased at T2 , T3 and T4 as compared with the baseline (T1 ) in both groups, but the increase was significantly larger in group C than in group U(P

Objective To investigate the protective effect of ulinastatin on myocardium against ischemia-reperfusion injury in open heart surgery with cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅰ - Ⅱ patients undergoing atrioseptopexy or surgical repair of VSD under CPB were randomly divided into two groups: in ulinastatin group (U n = 10) patients received ulinastatin 12000 unit?kg-1, half of the dose was given iv, 10 min before aorta cannulation and another half was added into the priming fluid; in control group (C n = 10) the patients received same volume of saline instead of ulinastatin. Premedication consisted of intramuscular pethidine 1 mg?kg-1 and scopolamine 0.01 mg?kg-1 .Anesthesia was induced with midazolam 0.1 mg?kg-1, fentanyl 10 ?g?kg-1 and pancuronium 0.1 mg**kg-1 and maintained with fentanyl, enflurane or isoflurane, diazepam and pancuronium. Arterial blood samples were taken before CPB (T1), at release of the aortic cross-clamp (T2), 30 min after aortic release (T3), 4h and 24h after discontinuation of CPB (T4, T5 ) for determination of plasma levels of cardiac troponin I (cTnI), creatine phosphokinase (CK) and creative phosphokinase isoenzyme (CK-MB) .Results The demographic data were comparable between the two groups. The CPB time, aortic cross-clamping time and duration of operation were also comparable. The plasma cTnI level and CK, CK-MB activity were all within normal range before CPB in both groups. In group C the plasma level of cTnI started increasing at T2, peaked at T4 and started decreasing at T5. In group U the plasma level of cTnI at T3 and T4 was significantly higher than the baseline (P

Objective To study the diagnosis,treatment and therapeutic results of 11 patients who suffered from mucinous tumor of the bile duct.Methods Eleven patients who were diagnosed to suffer from mucinous tumor of the bile duct were retrospectively studied.Three patients who presented with obstructive jaundice were diagnosed on ERCP,and 8 patients who had extra-and intrahepatic cholangiolithiasis were diagnosed by biopsy during choledochoscopy.Results One of the 3 patients who underwent ERCP died from obstructive jaundice after failed drainage of bile using endoscopic nasobiliary drainage (ENBD).The remaining two patients underwent laparoscopic common bile duct exploration and T tube drainage.The eight patients who had extra-and intrahepatic cholangiolithiasis were diagnosed by biopsy during choledochoscopy.Conclusions The clinical presentation of mucinous tumor of bile duct is non-specific and the preoperative misdiagnosis rate is high.Common bile duct exploration,T tube drainage and long-term T tube drainage is a good way to treat mucinous tumor of the bile duct.

Objective To investigate the effect of penehyclidine hydrochloride ( PHC) pretreat?ment on nuclear factor erythroid 2?related factor 2∕heme oxygenase?1 ( Nrf2∕HO?1) signaling pathway in re?nal tissues of rats with rhabdomyolysis?induced acute kidney injury ( AKI) . Methods Thirty?six pathogen?free male Sprague?Dawley rats, weighing 200-220 g, were assigned into 3 groups ( n=12 each) using a random number table: control group (group C), group AKI and PHC pretreatment group (group PHC). Rhabdomyolysis was induced by intramuscular injection of 50% glycerol 10 ml∕kg in bilateral hindlimbs. PHC 0?2 mg∕kg was injected intraperitoneally at 30 min before glycerol was injected intramuscularly in group PHC. At 1 and 6 h after glycerol injection, serum was collected for determination of blood urea nitro?gen ( BUN) and creatinine ( Cr) concentrations, and bilateral kidneys were harvested for pathological ex?amination and for determination of HO?1 activity and expression of Nrf2 mRNA and HO?1 mRNA ( by quan?titative real?time polymerase chain reaction) , Nrf2 in nucleoprotein and total protein and HO?1 in total pro?tein in renal tissues ( by Western blot) . The damage to the renal tubules was scored. Results Compared with group C, the BUN and Cr concentrations in serum and renal tubular damage scores were significantly increased, the expression of Nrf2 in nucleoprotein and total protein and HO?1 in total protein was signifi?cantly up?regulated, and HO?1 activity was significantly increased in AKI and PHC groups, the expression of HO?1 mRNA was significantly up?regulated in group AKI, and the expression of Nrf2 mRNA and HO?1 mRNA was significantly up?regulated in group PHC (P<0?01 or 0?05). Compared with group AKI, the BUN and Cr concentrations in serum and renal tubular damage scores were significantly decreased, the ex?pression of Nrf2 in nucleoprotein and total protein and HO?1 in total protein was significantly up?regulated, and HO?1 activity was significantly increased in group PHC ( P<0?01 or 0?05) . Conclusion The mecha?nism by which PHC pretreatment attenuates rhabdomyolysis?induced AKI may be related to activation of Nrf2∕HO?1 signaling pathway in renal tissues of rats.

OBJECTIVE:To establish a method for simultaneous determination of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate in Xiaoer huadu powder.METHODS:HPLC method was adopted.The separation was performed on Waters SunFireTM-C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelength was set at 238 nm,and column temperature was 25 ℃.The sample size was 10 μL.RESULTS:The linear ranges of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate were 8.808-88.08 μg/mL(r=0.999 8),1.778-17.78 μg/mL(r=0.999 6),2.533-25.33 μg/mL(r=0.999 9),respectively.LOQ were 4.404,0.889,2.533 μg/mL;LOD were 1.101,0.445,1.267 μg/mL.RSDs of precision,stability and reproducibility tests were all lower than 2％.The recoveries were 95.08％-99.61％ (RSD=1.77％,n =9),96.93％-99.94％ (RSD=0.92％,n=9),98.33％-102.05％ (RSD=1.27％,n=9).CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for simultaneous determination of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate in Xiaoer huadu powder.

Objective To evaluate the effects of noninvasive positive pressure ventilation on the severe cases of hand foot and mouth disease (HFMD).Methods Eighty-six cases of severe HFMD admitted to our hospital between Apr 2009 and Aug 2010 were divided into two groups based on the time when admitted to our hospital.Thirty-eight cases (group A,Apr to Jul,2009) received routine treatment and 48 cases (group B,Apr to Aug,2010) were ventilated with nasal continuous positive airway pressure based on routine treatment.The difference of the total efficiency was compared between two groups.Results Twenty-five out of 38 patients were cured,six showed improved signs,and seven showed no improvement in group A,of which the total efficiency was 81.5％.Forty out of 48 patients were cured,seven showed improved signs,and one showed no improvement in group B,of which the total efficiency was 97.9％.The clinical effect of group B was much better than group A and the difference was statistically significant ( x2 =6.71,P ＜0.05).Conclusion Early nasal continuous positive airway pressure has most valuable effect on HFMD and is helpful in preventing -HFMD from getting worse.

Objective To study the CT and MRI findings of hemorrhagic and necrotic nasal polyps. Methods The imaging data of 17 cases with hemorrhagic and necrotic nasal polyps confirmed by surgery and pathology were analyzed retrospectively. CT was performed in 14 cases, MRI in 16 cases, of which 15 also underwent contrast-enhanced MRI. Results All 17 lesions with well-circumscribed margin originated in the areas of maxillary sinus ostia and extended into adjacent nasal cavity and maxillary sinus. The lesions appeared as lobular shape in 16 cases and oval shape in 1 case. On non-enhanced CT, 14 lesions showed heterogenous soft tissue density masses, the hyperdense strip and nodule were detected on the periphery and in the center of 2 lesions respectively. All the involved bony walls were compressed and remodeled with focal defect,especially in the medial wall of maxillary sinus. On MRI, all 16 lesions revealed inhomogenous signal. The central region of the lesions appeared hypointense signal on T_1WI compared to gray matter and hyperintense signal on T_2WI with line-like hypointense signal septa in 14 cases, the irregular hypointense signal rims were also found on the periphery of 15 lesions on T_2WI, postcontrast MR imaging showed strongly inhomogenous enhancing masses with non-enhancing hypointense rim, the appearances of enhancement showed multiple nodules in 10 cases, patches in 4 cases and leaf-like in 1 case. The typical simple polyps were present in the ipsilateral nasal cavity of the lesions in 4 cases, extending into nasal vestibule anteriorly and choana posteriorly. On dynamic contrast-enhanced MRI in 11 cases, the timeintensity curves (TIC) showed increasing enhancement type in 7 cases and rapid enhancement and slow wash-out type in 4 cases. Conclusion The inhomogenous hyperintensity surrounded by the peripheral hypointense rim on MR T_2WI and marked nodular and patchy enhancement appearance are typical features of hemorrhagic and necrotic nasal polyps. CT is helpful to judge the nature of lesions, but difficultly confirms the diagnosis, while MRI should be the imaging modality of first choice for hemorrhagic and necrotic nasal polyps.

Objective To evaluate the effect of penehyclidine hydrochloride pretreatment on rhabdomyolysis-induced acute kidney injury (AKI) in rats.Methods Forty-two pathogen-free male SpragueDawley rats,weighing 200-220 g,aged 2 months,were randomly divided into 3 groups using a random number table:control group (group C,n =6),AKI group (n =18),and penehyclidine hydrochloride group (group PH,n =18).The model of rhabdomyolysis-induced AKI was established by injecting 50％ glycerol 10 ml/kg into the lateral muscle of bilateral hindlimbs in AKI and PH groups.The equal volume of normal saline was given in group C.Penehyclidine hydrochloride 0.2 mg/kg was injected intraperitoneally at 30 min before administration of glycerol in group PH.Six rats were selected at 1 h after administration of normal saline in group C,or at 1,6 and 24 h after administration of glycerol,blood samples were collected from the inferior vena cava for determination of the serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations by enzymic colorimetric method.The animals were sacrificed,and kidney specimens were obtained for pathologic examination and for determination of the expression of DJ-1 and phosphatase tensin homolog deleted on chromosome 10 (PTEN) encoding protein (by immuno-histochemistry and Western blot).The damage to the renal tubules was scored.Results Compared with group C,the serum BUN and Cr concentrations and renal tubular damage score were significantly increased,the expression of D J-1 was down-regulated,and the expression of PTEN protein was up-regulated in group AKI (P＜0.05 or 0.01).Compared with group AKI,the serum BUN and Cr concentrations and renal tubular damage score were significantly decreased,the expression of DJ-1 was up-regulated,and the expression of PTEN protein was down-regulated in group PH (P＜0.05 or 0.01).Conclusion Penehyclidine hydrochloride pretreatment can reduce rhabdomyolysis-induced AKI probably by up-regulating the expression of DJ-1 and down-regulating the expression of PTEN protein in rats.

Objective To explore the clinical characteristics and prognosis of congenital pulmonary artery sling (PAS) in children. MethodsThe clinical data of 38 children diagnosed with PAS during June 2009 and February 2015 were retrospectively analyzed. ResultsIn 38 PAS children, 35 cases (89.47%) were hospitalized for varying degrees of respiratory manifestations with recurrent cough (89.47%) and wheezing (84.21%) being the most common. The remaining 3 cases were found abnormal in routine preoperative examination and the diagnosis was confirmed after further examination. All 38 children were performed computer tomography angiography (CTA). Thirty-seven cases were diagnosed of PAS and diagnostic rate was 97.37%. One case was suspected of pulmonary dysplasia and diagnosed of PAS after operation. Twenty-six children received surgical treatment, of whom 25 children had pulmonary artery reconstruction (LPA). Seven children died during/after operation and 18 survived. The remaining 12 children received non-surgical treatment, of whom 9 died and 3 survived.ConclusionCardiac uhrasonography may reveal PAS in the early stage, while CTA is the best method for conifrmed diagnosis. LPA reconstruction is an important means of relieving left pulmonary artery oppression.

AIM: To explore the pathogenic mechanism of high altitude pulmonary edema(HAPE). METHODS: Haemodynamic changes and effects of 100 percent oxygen breathing were measured by Swan-Ganz thermistor catheters, high altitude healthy volunteers were served as controls. RESULTS: The important features of haemodynamic changes in HAPE: (1)Pulmonary arterial pressure was raised; (2)Pulmonary arterial resistance and cardiac output were raised; (3)Pulmonary artery wedge pressures and right atrial pressure were normal; (4)Pulmonary arterial pressure and resistance were induced by oxygen breathing. CONCLUSIONS: The normal pulmonary artery wedge pressures with a high cardiac output indicated that HAPE was recognized as a form of noncardiogenic pulmonary edema. The pulmonary hypertension may play an important role in the development of HAPE.