Extracorporeal Membrane Oxygenation ; Female ; Heart Failure ; therapy ; Humans ; Infant ; Postoperative Period ; Respiratory Insufficiency ; therapy ; Twins, Conjoined

Objective To study the therapeutic and protective effect of low tidal volume(LTV) ventilation in children with acute respiratory failure.Methods Forty-eight patients with respiratory failure were enrolled in our study.The patients were suffered from severe infection,trauma or after major operation.Besides general treatments,they were all given ventilation with LTV.Blood gas,ventilation parameters and complications related to ventilation were also measured.Results No significant difference was found between the patients with high tidal volume(HTV) and those with LTV in the results of improving respiratory acidosis.But the incidence of(ventilated-)induced lung injury(VILI) was lower in LTV patients.Conclusion LTV ventilation is preferable for children with acute respiratory failure and beneficial for alleviation of VILI.

To investigate the role of ICAM 1 in the aggregation of polymorphoneucleocytes (PMN) in the lungs at the early stage of burns. Myeloperoxidase (MPO) content in lung tissues and bronchoalveolar lavage fluid (BALF) was assayed. Intercellular adhesion molecule 1 (ICAM 1) and its mRNA expression in lung tissues were determined by immunohistochemical method and in situ hybridization. CD11b/CD18 expression on the circulating PMN were measured by flow cytometry. The results showed that levels of MPO in lung tissues and BALF were markedly higher than those of control after burn injury. Expression of ICAM 1 and its mRNA in the lung tissues and CD11b/CD18 on circulating PMN surface were significantly increased at 2, 6, 12, 24hr after burns. It suggests that PMN aggregation in the lungs might be related to increased ICAM 1 expression on pulmonary microvascular endothelial cells and CD11b/CD18 expression on PMN at the early stage of burn injury.

Objective To investigate the effect of ulinastatin on hippocampal neuron and matrix metalloproteinase-9 ( MMP-9 ) expression after ischemia-reperfusion injury rats, to reveal the mechanism of protection on hippocampus of ulinastatin.Methods The focal ischemia reperfusion model was made by thread embolism of middle cerebra1 artery, and ulinastatin was used.The animals were killed at 24 h after reperfusion was started.The sections of the brains were processed with Nissl staining and by immunohistochemistry with antibody of MMP-9.Results Corrected optical density (COD) of MMP-9 expression was significantly decreased after administration of ulinastatin.Also ulinastatin can obviously protect the structure of hippocampal neuron.Conclusion Ulinastatin could protect pyramidal cells in CA1 region from damage of ischemia-reperfusion injury and increase the number of normal neurons.Inhibition on MMP-9 expression was involved in the mechanism.

Objective To investigate the factors affecting the efficacy,safety and prognosis of R0 resection in hepatocellular carcinoma(HCC)patients with portal hypertension(PH).Methods Clinical data of 600 patients with cirrhosis related HCC undergoing hepatectomy at the Dept.of Hepatobiliary Surgery were studied retrospectively.According to whether the patients with portal hypertension or not,they were divided into PH group and non PH group.Postoperative complications and mortality were compared between the two groups.Kaplan-Meier was used to analyze influencing factors of patients with R0 postoperative survival.Cox regression risk model was used to analyze the risk factors.Results The operative mortality of PH group and non PH group was 3.6%(3/84)and 0.5%(1/216),respectively.The difference was statistically significant(P<0.05).The incidence of postoperative complications in PH group was 22.6%,significantly higher than 9.7% in non PH group(P<0.05),especially the incidence rate of the liver related complications(ascites>800 ml/d,hepatic insufficiency and liver failure).Alcoholism,with PH,AFP ≥20 ng/ml,tumor size>5cm and non-solitary type HCC(all P<0.05) were important factors for overall survival.Cox regression analysis showed that tumor size>5cm and non-solitary type HCC were independent predictors for survival.Conclusion PH combined with HCC patients after R0 resection can significantly increase the incidence of complications related to liver disease and mortality,tumor size >5cm and non-isolated HCC are the risk factors for long-term survival of patients.

[Abstract ] Toll like receptor 4 (TLR4) is a key member of the Toll like receptor family , and is a major receptor for lipopo-lysaccharide ( LPS) .After stimulating with LPS , TLR4 activation could cause the release of a series of inflammatory factors , and acti-vate the immune response of the organism .In recent years , LPS/TLR4 signal transduction has been widely studied , and it has become the most important research hotspot in the inflammatory reaction and its control method .In this paper , we review the recent progress of molecules involved in TLR 4 signaling pathway and their regulatory mechanisms .

Objective To assess and compare the the results of tricuspid annuloplasty performed with the Edwards MC3 and Kay methode.Methods From January 2010 to May 2014, 759 patients with function tricuspid regurgitation(FTR) secondary to left-sided valve disease received tricuspid annuloplasty.Cardiac ultrasound Heartbeat diagram were made to confirm the degree of tricuspid regurgitation, the diameter of tricuspid annulus, the pressure of pulmonary artery and the heart function both in the left and the right, and so on.Of them, 355 cases of male, female 404 cases, at the mean age of(54.1 ± 8.3) years old, with the heart function classical(NYHA) : Ⅰ 13, Ⅱ 177, Ⅲ 400, Ⅳ 169, the mean left ventricles ejection fraction(LVEF) was 0.53 ±0.04, the mean pulmonary artery pressure was(62.5 ± 17.6) mmHg(1 mmHg =0.133 kPa).The diagnosis include rheumatic heart disease 517 cases, degenerative disease 209 cases and infective endocarditis 33 cases.The operation include mitral annuloplasty 132 case, mitral replacement 295 cases, mitral annuloplasty and aortic replacement 20 cases, mitral and aortic replacement 388 cases, CABG 86 cases and Maze Ⅲ methode 23 cases.The degree of tricuspid regurgitation before the operation were class Ⅰ 88, Ⅱ 189, Ⅲ 352 and V 130.From January 2010 to May 2012, 447 cases received Kay' s methods and 312 cases received MC3 annuloplasty ring during May 2012 to May 2014.In the MC3, We use the rings in 28mm size were 79 cases, 30 mm 155 cases, 32 mm 66 cases and 34 mm 12 cases.Results There were no death, reoperation and adverse events in both groups.There were no diffent in the aorta block time, the circulation bypass time, the time of mechanical ventilation, stay in ICU and in the hospital(P ＞ 0.05).All the patient were followed up regularity.The rat of follow up was 90.4％ (686/759), and the mean time of follow up was(39.9 ± 7.7) month.The patients' s EF increased, inner diameter of the right ventricle decreased in both group.There were no severe TR in the patients in the Kay group within 3 months, and 1 case of severe TR 1 year later, as 5 cases at 2 years and 12 cases after 2 years.The regurgitation volume of tricuspid was (3.4 ± 1.4) ml at the moment of 3 month, (6.5 ± 2.1) ml at 1 year, (7.9 ± 2.5) ml at 2 years and (12.4 ± 4.7)ml 2 years later.In the MC3 group, there were no severe TR in the patients during all the stage of fellow-up.There were on regurgitation in the patient within 3 months, 1 case of Class Ⅲ of TR at 1 year and 3 cases of Class Ⅲ at 2 years, without worse TR happen.At the same stage as in MC3 group, the regurgitation volume was(2.9 ±0.9) ml,(3.5 ±1.3) ml and(3.4 ±2.1) ml.The result in MC3 group was similar with Kay group(P ＞0.05) in short term, but much better in the long-term(P ＜ 0.05).Conclusion The Kay methode has good early result, but not the same good in the long-term, which can be applied in the elder persons or the patient without long Life expectancy.And the MC3 ring can correct the FTR enduringly and effectually, specifically the size in small one which behaves perfectly.The MC3 ring should be used in the young patient or the patient wants more.

Aged ; Anastomosis, Surgical ; Esophageal Neoplasms ; surgery ; Female ; Gastroplasty ; methods ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Male ; Middle Aged

Endometrial Neoplasms ; metabolism ; pathology ; secondary ; Female ; Humans ; Mesentery ; Middle Aged ; Neprilysin ; metabolism ; Peritoneal Neoplasms ; metabolism ; pathology ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Sarcoma, Endometrial Stromal ; metabolism ; pathology ; secondary

Objective To observe the mucosal structure and aberrant crypt foci (ACF) of small and large bowel in rats induced by DMH and to explore the growth and development of small intestinal tumors.Methods Thirty-four male Wistar rats were randomly divided into two groups:DMH-induced group (25 rats) and control group (9 rats).After 30-32 weeks,thess rats were performed with laparotomy,and their small intestine and large intestine were dissected.The mucosa structure and ACF were observed and recorded.The tissues of small intestine and large intestine in control group and the samples of tumor,adjacent normal tissues and ACF tissues in DMH-induced group were subjected to hematoxylin and eosin (H&E) staining and were used to observe histological changes by microscopy.Results The mucosa structure and histological changes of small and large intestine were normal in control group.There were 7 small intestinal tumors and 28 large intestinal tumors in DMH-induced group,respectively.The surface structures of small intestine mucosa and tumor adjacent mucosa were normal.The scattered lymphocytes infiltration was observed in small intestinal mucosa and tissues adjacent to tumor in DMH-induced group,while ACF was observed in large intestinal mucosa and tissues adjacent to tumor in DMH-induced group.Conclusions The occurrence of small intestinal tumors may be induced by some cells directly in the carcinogenesis under the role of the carcinogenic factors in small intestine mucosa with poor tumor differention and high malignancy.The development of small intestinal cancer does not follow the ‘ACF-adenoma-adenocarcinoma' model in large intestine.