Objective To investigate the therapeutic effect of continuous intravenous pralidoxime chloride infusion in acute organophosphorus pesticide poisoning(AOPP).Methods The patients with severe AOPP were randomly divided into 3 groups:(1)group 1(n =51)received a bolus injection of pralidoxime chloride 2.Og followed by continuous intravenous infusion at 0.25 g/h.(2)group 2(n = 51)received a bolus injection of pralidoxime 2.Og followed by continuous intravenous infusion at 0.5g/h.(3)group 3(n = 50)received intravenous drip of pralidoxime 2.Og for 3 times a day.Efficacy was compared among 3 groups on the basis of time to reach atropinization,recovery of cholinesterase activity .cumulative amount of atropine,incidence of recurrence of pesticide poisoning,intermediate syndrome,and hospitalization days,etc.Results Efficacy in patients receiving continuous intravenous therapy was significantly different from the third group.But there was no significant difference in efficacy between the first and second groups.Conclusion The patients with AOPP can be effectively treated by a loading dose followed with continous intravenous pralidoxime chloride infusion.

Objective To investigate the value of MSCT in assessing bowel ischemia of small-bowel obstruction .Methods CT images and electronic medical records of 40 patients with small-bowel obstruction were retrospectively evaluated.Patients were treated by surgery.The CT signs of bowel ischemia were recorded.Relationship between CT signs and bowel ischemia were tested by Fisher exact andχ2 test.Sensitivity and specificity of MSCT for ischemia were also assessed.Results Bowel ischemia was confirmed at surgery and/or pathological examination in 21 of 40 patients.Diminished enhancement after contrast agent injection was the most common sign in bowel ischemia patients.The signs of increased bowel-wall attenuation on non enhanced images and diminished enhancement after contrast agent injection were significantly associated with ischemia (P <0.000 1).The signs of increased bowel-wall attenuation on non enhanced images and pneumatosis intestinalis had high sensitivity(100%).The sign of diminished enhancement after contrast agent injection had high sensitivity(95.2%)and specificity(94.7%).Conclusion MSCT is accurate in assessing bowel ischemia of small-bowel obstruction, and improves the timeliness and diagnosis for this disease.

Objective:To analyze the clinical guidance value of 3.0 T three-dimensional time of fly magnetic resonance angiography (3D-TOF-MRA) in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) treatment.Methods:The clinical and imaging data of 60 TN patients who underwent MVD treatment in Jinhua People′s Hospital from January 2019 to December 2019 were retrospectively analyzed. All patients underwent 3D-TOF-MRA examination before the surgery. The relationship and direction of the trigeminal neuralgia and surrounding blood vessels were observed, the responsible blood vessels that compressed the nerves before the surgery were determined, and vascular nerve compression (NVC) was clarified.Results:Among the 60 TN patients, pain symptoms of 52 patients (86.67%) completely disappeared after the surgery, and the pain symptoms of the remaining 8 patients (13.33%) were also significantly relieved. There was no statistically significant difference between 3D-TOF-MRA examination and MVD surgery in the judgment of the responsible vessel ( P>0.05). The positive rate of TN diagnosed by MVD surgery was 98.33% (59/60), and the positive rate of TN diagnosed by 3D-TOF-MRA was 91.67% (55/60), with no statistically significant difference ( P>0.05), and with highly consistency by Kappa test ( Kappa value=0.867). The area under the curve (AUC) of TN diagnosed by 3D-TOF-MRA through receiver operating characteristic (ROC) curve analysis was 0.730 (95% CI 0.526~0.934). The incidence of NVC diagnosed by 3D-TOF-MRA was 63.33%(38/60), and the incidence of NVC seen by MVD surgery was 61.67%(37/60). There was no statistically significant difference in the diagnosis of NVC between 3D-TOF-MRA and MVD surgery. ( P>0.05). Conclusions:The 3D-TOF-MRA examination can more accurately know the position, orientation, shape and compression degree of the responsible blood vessel in TN patients, which has important guiding value for the clinical diagnosis of TN and preoperative evaluation of MVD.

Objective To evaluate the efficacy of acting κ opioid receptor for prevention of high altitude pulmonary edema (HAPE) in rats.Methods Forty male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were randomly divided into 5 groups (n =8 each) using a random number table:control group (group C),hypobaric hypoxia group (group H),normal saline + hypobaric hypoxia group (group NH),U50488H (a selective kappa-opioid receptor agonist) + hypobaric hypoxia group (group UH),and nor-binaltorphimine (norBNI,a selective kappa-opioid receptor antagonist) + U50488H + hypobaric hypoxia group (group NUH).The rats were put into the hyperbaric chamber and exposed to hypobaric hypoxia (atmospheric pressure 355 mmHg,partial pressure of oxygen 74 mmHg) for 2 days to induce HAPE.At 3 days before HAPE,normal saline 0.5 ml,U50488H 1.25 mg/kg,and nor-BNI 2.0 mg/kg were injected intraperitoneally once a day in NH,UH,and NUH groups,respectively,and in addition U50488H 1.25 mg/kg was injected intraperitoneally 10 min later in NUH group.After 2 h exposure to hypobaric hypoxia,mean pulmonary artery pressure (mPAP) was detected,and arterial blood samples were collected for determination of serum malondialdehyde (MDA) and erythropoietin (EPO) levels.The rats were then sacrificed and lungs were removed for microscopic examination and for determination of the levels of nitric oxide (NO),inducible nitric oxide synthase (iNOS),MDA,superoxide dismutase (SOD),endothelin-1 (ET-1),thromboxane B2 (TXB2),and 6-keto-prostaglandin F1α (6-keto-PGF1α) in lung tissues.Lung water content and TXB2/6-keto-PGF1α ratio was calculated.Results Compared with group C,mPAP,lung water content,ET-1,MDA,TXB2 and 6-keto-PGF1α levels,TXB2/6-ketoPGF1α ratio,and serum MDA and EPO levels were significantly increased,and iNOS,NO and SOD levels were decreased in the other four groups (P ＜ 0.05).Compared with group H,mPAP,lung water content,ET-1,MDA,TXB2 and 6-keto-PGF1α levels,TXB2/6-ketoPGF1α ratio and serum MDA and EPO levels were significantly decreased,and iNOS,NO and SOD levels were increased in UH group (P ＜ 0.05),and no significant changes were found in the indexes mentioned above in NH and NUH groups (P ＞ 0.05).The pathological changes of lung tissues were significantly attenuated in group UH as compared with H group.Conclusion Acting κ opioid receptor can produce prevention for HAPE in rats,and inhibition of lipid peroxidation and correction of the imbalance between vasoconstrictive factors and vasodilative factors may be involved in the mechanism.

Objective Transforming growth factor-β( TGF-β) can regulate the expressions of matrix metalloproteinase (MMP) and matrix metalloproteinase (TIMP) inhibitors, thus affecting the reconstruction of extracellular matrix (ECM) after lung in-jury.So far, little is known about the regulation of TGF-β1 and MMPs/TIMPs ratio in endotoxin-induced lung injury as well as about the exact mechanisms of ECM reconstruction disorders .This study was to investigate the effects of TGF-β1 antibodies on the expressions of MMP and TIMP inhibitors and lung injury fibrosis in rats with endotoxin-induced acute lung injury . Methods Fifty-six male SD rats were randomly divided into three groups, normal (n=16), LPS (n=20), and LPS+TGF-β1(L+T, n=20).The rats of the LPS and L+T groups received intraperitoneal and intra-tracheal injection of endotoxin to induce lung injury fibrosis , the latter intrave-nously injected with TGF-β1 antibodies previously .The normal rats received intra-tracheal and intra-abdominal injection of the same a-mount of saline.At 1, 5, 9 and 14 days after modeling, all the rats were killed and blood and lung tissue samples obtained to detect the wet/dry lung tissue ( W/D ) ratio, diffuse alveolar damage ( DAD) score, hydroxyproline activity ( Hpy) , and the expressions of TGF-β1 , MMP-2 and TIMP-1. Results The DAD score, Hpy ac-tivity, and expressions of TGF-β1 , MMP-2 and TIMP-1 were signifi-cantly higher in the LPS group than in the normal control ( P <
0.05), and so were the DAD score, Hpy activity, MMP-2, and TIMP-1 in the L+T group than in the controls (P<0.05).Com-pared with the LPS group, Hpy, TGF-β1 and TIMP-1 were markedly decreased in the L +T group (P<0.05).The expression of MMP-2 was gradually increased at 1, 5 and 9 days after modeling , reaching the peak at 9 days and then beginning to decline .The Hpy activity, TGF-β1 and TIMP-1 expressions kept rising after modeling . Conclusion The MMP/TIMP imbalance and ECM reconstruc-tion disorders mediated by the TGF-β1 signaling pathway may be an important cause of fibrosis in endotoxin-induced lung injury . TGF-β1 antibodies can exert a protective effect by alleviating lung injury fibrosis .

Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.

The electrocatalytic oxidation of dopamine (DA) was studied by electrochemical approaches at a carbon ionic liquid electrode (CILE) modified with the composite film of nafion and L-aspartic acid (NL-CILE). The CILE was fabricated by replacing non-conductive organic binders with a room-temperature hydrophobic ionic liquid, 1-butyl-3-methyl-imidazolium hexafluorophosphate. The composite film of NL was used as matrix to adsorb DA and catalyze the oxidation of DA in phosphate buffer solution (PBS). The electrochemical response of DA was investigated at the NL-CILE, the traditional carbon paste electrode (TCPE), CILE and the nafion modified CILE (N-CILE) in 0.1M PBS (pH 7.4), respectively. The results showed the superiority of NL-CILE to N-CILE, CILE and TCPE in terms of provision of higher sensitivity, faster electron transfer and better reversibility. Under optimum condition, the oxidation peak current was rectilinear with DA concentration range from 0.1μM to 0.1mM, with a detection limit of 0.03μM (S/N=3) by differential pulse voltammetry. The proposed method was applied to determine DA in samples successfully.

Objective To explore bladder carcinoma eystectomy and orthotopic ileal neobladder postoperative,the impact of new bladder on upper urinary function.Methods Twenty-eight patients with muscle invasive bladder urothelial carcinoma undergoing cystectomy W-shaped orthotopic ileal neobladder in Department of Urology of the Nuclear Industry 215 Hospital of Shaanxi Province(Mar.2006-Jun.2010)were investigated.All patients were followed for over 2 years.Assessment items included creatinine determination,urinary B-Ultrasound determination of the amount of residual urine volume and hydronephrotic cystography.Results Four weeks after the operations,all patients were removed bladder catheter angiography and found no obvious contrast extravasation.After 3 months mild hydronephrosis was found in 8 cases (28.6％),including 2 cases (7.1％) before surgery associated with hydronephrosis,the difference being not statistically significant(x2=0.49,P ＞ 0.05).The mild hydronephrosis was found in 5 cases (17.9％) 2 years postoperation,whithout statistically significant difference compared with preoperation (x2 =0.22,P ＞ 0.05).Preoperative serum creatinine was (72.92 ± 14.58) mmol/L,while 3 months after surgery serum creatinine was (83.42 ± 15.18) mmol/L (t =-6.43,P ＜ 0.05).Preoperative and postoperative serum creatinine was within the normal range.Two years after surgery serum creatinine was (82.50 ± 14.39) mmol/L,with significant difference compared with that of preoperation (t =-4.67,P ＜ 0.05),but were in the normal range,no clinical significance,the postoperative 3 months bladder capacity (160 ± 23) mL,while 2 years later bladder capacity residual urine volume of (58.7 ± 9.7) mL and (430 ± 21) mL,residual urine volume (61.3 ± 37.1) mL(t =-0.37,P＞ 0.05).Conclusion Orthotopie ileal bladder ideal substitute for postoperative cystectomy with less impact on the upper urinary tract function.

Objective To assess the protective effect of the proteasome inhibitor bortezomib on rat liver subjected to bile duct obstruction. Methods Thirty rats were divided randomly into three groups, which were sham-operation group (SO group), bile duct ligation control group (Con group) and bortezomib group (Bor group). All rats in the Con group underwent ligation of the common bile duct, and rats in the Bor group were given bortezomib intrabominally at-1 d, 4 d post-ligation of the common bile duct. All the rats were sacrificed at 7 d post-surgery. ALT, TB and TBA levels were determined. The expression of NF-κB p65 was assessed using immunohistological staining. RT-PCR was employed to detect TNF-α mRNA levels in liver samples. Results There was no significance in the levels of TB and TBA between Con and Bor groups. The ALT revel in the Bor group [(92.4±21.4)μmol/L]was significantly lower than that in the Con group [(145.7 ±33.5) μmol/L], P＜0.05. The positive staining rate of NF-κB p65 subunit in the Bor group showed significant lower value (11.6% ±2.7 % ) compared to that in the Con group (15.5 %±4.3 % ), P＜0.05. The expression ratio of TNF-α mRNA in the Bor group was 1.0± 0. 2, which also significantly lower than that in the Con group (1.3±0.4), P＜0. 05. Conclusion These data suggest that the proteasome inhibitor bortezomib reduces rat hepatocyte injury in the bile duct ligation by mechanisms associated with the inhibition of NF-κB as well as the attenuation of inflammation.

Objective To determine the EC50 of dexmedetomidine hydrochloride ( DEX) which causes disappearance of explicit memory by process dissociation procedure (PDP). Methods Forty patients those who had senior middle school or higher educational background undergoing lower extremity surgery with grade ASA Ⅰ or Ⅱ, without hearing impairment, dysphasia,nervous system disorders,and having no drugs in the treatment of the central nervous system were included.PDP was applied to establish study table and record, and calculate performance of explicit memory and implicit memory. Memory performance was statistically compared with 0, 0 memory was considered to be statistically significant and disappearance, respectively.Sequential method was used for determination.According to explicit memory disappearance or not,target concentration of the next patient was adjusted (increase or decrease).DEX target concentration of the first patient was set to 4 ng?mL-1,and the ratio of target concentration between the adjacent patients was 1.2.If the explicit memory of the former patient disappeared,the target concentration of the next patient was decreased by 1 concentration gradient;if the explicit memory of the former patient did not disappear,the target concentration of the next patient was increased by 1 concentration gradient, and so forth. All the 40 patients were determined.The median effective dose (D1) and 95% confidence interval (CI) of DEX were calculated. Results The ED50 of DEX causing explicit memory disappearance was 5.23 ng?mL-1,and the 95% CI was 4.07-6.39 ng?mL-1. Conclusion In clinical,target concentration of dexmedetomidine hydrochloride 5.23 ng?mL-1 levels for sedation,can cause half of patients’ explicit memory disappear,so as to avoid intraoperative awareness.