Objective To explore the clinical significance of perioperative serum N-terminal pro-BNP(NT-proBNP)testing in patients with cardiac valve replacement.Methods The content of perioperative plasma NT-proBNP in 296 patients with cardiac valve replacement was detected,the relationship between preoperative plasma NT-proBNP content and heart function classification was analyzed,the postoperative changes were observed and the plasma NT-proBNP levels were compared among the death cases, the patients with complications and without complications.Results The left ventricular ejection fraction(LVEF)and plasma NT-proBNP content had statistical differences among different cardiac functional classifications(F =5.268,8.173,P <0.05),preopera-tive serum NT-proBNP level was positively proportional to the cardiac function classification(r =-0.776,P <0.01)and inversely proportional to LVEF(r=-0.472,P <0.05);on postoperative 1 d,plasma content of NT-proBNP reached the peak,there was sta-tistically significant difference compared with before treatment,(t=20.913,P <0.05),then which was gradually declined on post-operative 3,5,7 d.The preoperative plasma NT-proBNP content and postoperative plasma NT-proBNP peak levels in the death pa-tients and the patients with complications were higher than those in the patients without complications(P <0.05 ),the difference was statistically significant(P <0.05 ).Conclusion Preoperative plasma NT-proBNP concentration in the patients with cardiac valve replacement can reflect the cardiac function condition,the postoperative plasma NT-proBNP content is increased at the early stage,then gradually decreased,The increase of plasma NT-proBNP concentration before and after operation has a certain clinical value in predicting prognosis of the patients.

Objective To validate and compare the two spinal microdialysis techniques: a linear tissue probe (LM-3) in the spinal dorsal horn and a loop probe in the cerebral spinal fluid (CSF) in determining peripheral nociceptive stimulation-evoked glutamate (Glu) release in the spinal cord of freely moving rats. Methods Twenty-eight adult male Wistar rats weighing 300-350 g were randomly divided into two groups: in group A a LM-3 probe was implanted into the spinal dorsal horn and in group B a loop probe was placed in the CSF. Twenty-four hours after the implantation of the probe, microdialysis was initiated with perfusion of modified Ringer' s solution at a low flow rate of 5 ?l?min-1 . Following an 1 h equilibration phase the baseline Glu concentrations were measured every 10 min for 1 h. Thereafter 50 ?lof 5% formalin was injected into one hindpaw of the rats and samples were collected every 10 min for 90 min. Furthermore 8 rats in group A were further divided into 2 subgroups to investigate the effects of the flow rate of microdialysis and composition of perfusate on the baseline Glu release.Results The baseline levels of Glu were (0.82?0.09) ?mol?L-1 with LM-3 probe and (5.96?0.22) ?mol?L-1 with the loop probe. In group A (LM-3 probe) when the flow rate of the modified Ringer's solution was decreased from 5 to 2 ?l?min-1 the extracellular Glu concentrations were increased to 223%?7% of the baseline (n = 4) , whereas perfusion with artificial CSF reduced Glu concentrations to 62% ?10% of the baseline (n = 4) . Injection of formalin into the hindpaw induced a short-lasting but significant increase in Glu concentration with a similar profile and time course using either of the two microdialysis approaches. Conclusion Microdialysis in the dorsal horn or in the CSF are both effective techniques to assess Glu release in the spinal cord of rats. Peripheral nociceptive input induces a short-lasting increase in Glu release with a similar profile and time course using either of the two microdialysis approaches. The microdialysis of the dorsal horn provides a useful tool to precisely locatewhere the release of the neurotransmitter occurs, whereas the loop probe in CSF is more reproducible for simultaneous investigation of drug effects.

Objective To explore CT diagnosis of atypical meningioma .Methods 18 cases of atypical meningioma were undergone MR plan scans, among them,17 cases were examined by CT contrast scans. All cases were proved by operation and pathology.Results The tumors appeared as mixed density in 11 cases,cystic in 4 cases,complete enhancement in 3 cases.Conclusion The tumors to be comfirmed at external cerebra is the key in diagnosing atypical meningioma exactly by CT.Atypical manifestations can be seen in a few meningiomas,therefore, it is significant in differential diagnosis of meningioma.

Objective: To investigate the effect of urinastatin on the expression levels of NF-?B and TNF-? liver transplantation in patients. Methods: Thirty-six patients of late stage hepatic cirrhosis were randomly divided into two eaquel groups: the experiment group was administrated by urinastatin 300 000 U and saline 10 mL via venous injection during liver transplantation, the control group was administrated 10 mL saline by venous injection at the same time. The blood samples were harvestd at 1, 2, 4 and 6 h after the blood recovery of donated liver. The nuclear factor-?B (NF-?B) P65 relative level of blood was detected by Western blot analysis and the TNF-? level of blood was detected by double antibody Sandwich enzyme linked immunosorbent assay. Serum ALT and AST were also measured. Results: The expression level of serum NF-?B p65, TNF-? in the experiment group were lower than those in the control group, and the difference was significant(P

Objective To analyze the correlation between serum lipoprotein associated phospholipase A 2(Lp‐PLA2) with five traditional inflammatory factors of TC ,TG ,LDL‐C ,hs‐CRP and Hcy in the patients with coronary heart disease(CHD) ,and to in‐vestigate the relationship between its concentration with the lesions and severity of CHD .Methods Two hundreds cases of CHD were selected as the lesion group(which was subdivide into single vessel lesion ,double vessel lesion and three vessel lesion) ,at the same time ,100 persons undergoing physical examination were selected as the control group .The correlation between Lp‐PLA2 with five traditional inflammatory factors of TC ,TG ,LDL‐C ,hs‐CRP and Hcy was analyzed .The differences of Lp‐PLA2 in the lesion group and the control group were compared and the relation between Lp‐PLA2 level with lesion vessels number was analyzed .Re‐sults Lp‐PLA2 was significantly correlated with LDL‐C ,Hcy ,TC and hs‐CRP(P<0 .05) and had no relation with TG(P>0 .05) , the level of Lp‐PLA2 in the lesion group was significantly higher than that in the control group (P<0 .01) ,the Lp‐PLA2 level was elevated with the number of coronary lesion vessels ,but the correlation is unobvious(P>0 .05) .Conclusion High concentration of Lp‐PLA2 is a risk factor for coronary atherosclerosis ,but the correlation between the Lp‐PLA2 level and the severity of coronary arterial lesion needs further study .

Objective To investigate the effects of ABO blood group factors on erythrocyte suspension ( RCS) transfusion reactions in patients. Methods TestⅠA total of 12 600 patients in whom RCS was transfused during operation at the department of anesthesiology of 11 hospitals of Inner Mongolia from January 2006 to January 2014 were selected. The occurrence of transfusion reactions ( fever [ an increase in body temperature>1 ℃ than that before transfusion] , allergy, hemolysis) was recorded in the patients. Test Ⅱ A total of 120 RCS?transfused patients of both sexes, aged 18-55 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, who underwent surgical operation, were divided into 4 groups ( n=30 each) according to the blood group: blood group A group ( group A) , blood group B group ( group B ) , blood group O group ( group O ) and blood group AB group ( group AB) . The standard for RCS transfusion was defined as hemoglobin ( Hb) <7 g∕L, and Hb was maintained>10 g∕L. Before induction of anesthesia ( T1 ) , before blood transfusion ( T2 ) , and at 5 min, and 1, 6 and 24 h after blood transfusion ( T3?6 ) , blood samples were collected from the central vein for determination of the plasma tumor necrosis factor?alpha ( TNF?α) , interleukin?4 ( IL?4 ) and IL?10 concentrations by enzyme?linked immunosorbent assay. Results Among the 12 600 RCS?transfused patients, 216 cases developed transfusion reactions, and the incidence of transfusion reactions was 1.714%. For the patients of different blood groups, the incidence of transfusion reactions from the high to the low was blood group B, blood group AB, blood group A, and blood group O in turn ( P<0. 05 or 0.01) . Compared with group B, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in the other three groups ( P<0.05) . Compared with group AB, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in A and O groups (P<0.05). Compared with group O, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in group A ( P<0. 05 ) . Conclusion ABO blood group factors affect RCS transfusion reactions in the patients, and the incidence of transfusion reactions from the high to the low is blood group B, blood group AB, blood group A, and blood group O in turn.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

OBJECTIVETo investigate the clinical effects of arthroscopic repair and arthroscopic-assisted small incision repair for the treatment of rotator cuff injury.

METHODSThe clinical data of 86 patients with rotator cuff injury from January 2012 to January 2015 were analyzed retrospectively. All the patients were divided into two groups: arthroscopic assisted small incision repair group(group A) and arthroscopic repair group(group B). There were 46 patients in group A, including 25 males and 21 females, with an average age of (52.8±7.8) years old. And there were 40 patients in group B, including 23 males and 17 females, with an average age of (53.2±9.5) years old. Several indexes such as shoulder joint activity, muscle strength and ASES, UCLA and VAS scores were examined before and after operation to compare therapeutic effects between these two groups.

RESULTSAll the patients were followed up, and the mean time was 20.8 months (ranged, 18 to 35 months). The results of patients in group A as follows: range of abduction motion of shoulder joint was (131.4±18.8)°, external rotation was (64.9±8.8)°, and internal rotation was(63.7±7.3)°. Results of patients in group B as follows: range of abduction motion of shoulder joint was(132.3±16.9), external rotation was(65.1±9.4)°, and internal rotation was(64.4±8.1)°. All the patients had better shoulder mobility than those before operation, but there were no significant differences between two groups after operation. Postoperative scores of patients in group A: ASES was 88.4±8.9, UCLA score was 29.6±3.6, VAS was 1.4±0.3; and in group B, the above scores were 89.5±9.6, 30.8±4.1 and 1.3±0.4 respectively. All the patients had better scores than those before operation, but there were no significant differences between two groups after operation.

CONCLUSIONSArthroscopic repair and arthroscopic-assisted small incision for repair of rotator cuff injury has clinical curative effects to some extent, and these two methods could improve the safety and reliability of surgical treatment.

Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.

Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.