Objective To study the effect of platelet-derived growth factor(PDGF)and lysosomes on lung injury in macaque with early-phase endotoxie shock.Method Eleven macaques were randomly divided into two groups,namely,control group(Co group,n=5)iand endotoxic group(En group,n=6).The macaque of the Co group injected with 1 ml/kg normal saline and the macque of the En group received a dose of 2.8 mg/kg Lipopolysaccharides(LPS)i.v.The blood gas was detected at 120 minutes after LPS challenging. Uhrastructure,cytochemistry of acid phosphatase(ACPase)detection by electronic microscopy and immunohistochemical assay of PDGF were completed in hmgs of all the macaque .Results Administration of LPS did not change the parameters of gas exchange,namely,PaO_2,PaO_2/Fi and PaCO_2.In the early phase,of endotoxic shock,ACPase activity products increased and lysosome destroyed in the alveolar cells.The pathologic changes of alveolus,such as degeneration of vessel endothelium,injury of alveolar epithelium and damage of basement membrane,and transudation of blood component were observed by electron microscopy in the En group. However,no pathological changes were found in the control group.By immunohistochemical staining,PDGF on alveolar wall in the En animals was observed,whereas no PDGF protein in the Co macaques was noticed. Conclusions Administration of LPS induced the expression of PDGF in the alveolar wall and lysosome injury in the alveolar cells,as a result of alveolar damage in early-phase endotoxin shock.In the meantime,the parameters of gas exchanges did not change.The PDGF may play an important role in the pathogenesis of lung during the early-phase of endotoxin shock.

Objective:To summarize the early and intermediate outcomes of second-grade false-lumen endovascular occlusive repair (FLEVOR) for aortic dissection.Methods:The clinical data of 12 patients undergoing second-grade FLEVOR after proximal repair of aortic dissection at our center from Aug 2016 to Aug 2019 was retrospectively analyzed.Results:The mean age was (51.3±14.9) years old. Four patients received open repair due to Stanford type A aortic dissection previously, the other 8 patients underwent thoracic endovascular aortic repair for Stanford type B aortic dissection. The time to the proximal repair varied from 3 months to 16 years. The technical success rate was 100%. Visceral ischemia, early spinal cord ischemia and in-hospital death did not occur perioperatively. The mean follow-up time was 16.7 months. Persistent false lumen perfusion was found in 3 patients, complete thrombosis of false lumen was achieved in the other 8 patients. The maximum diameter of abdominal aorta decreased in 8 (72.7%) patients.Conclusions:FLEVOR could block the blood flow from the false lumen and induce the thrombosis of false lumen, which promotes the aortic remodeling. Meanwhile, FLEVOR could protect the blood supply of spinal cord and viscera, and reduce the risk of type Ⅱ endoleaks.

Objective To know the quality of iodized salt and the current situation of the salt coverage in Tibet,and to provide scientific basis for proposing proper prevention and control measures to Iodine dificiency disorders(IDD). Methods In 2008, according to the "Sampling Methods of the Main Products in the Salt Industry",one batch fifteen salt samples were collected in iodized salt processing factory in Tibet. Five townships were chosen in each county based on 5 different directions of east, south, west, north and center. If the monitoring county has less than five townships, then all of the townships were sampled. In each township, four villages were selected withrandom sampling and importance sampling. In each township, 15 households were selected for salt collection. Results A batch of 15 salt samples in a salt processing plant were tested, and all of them were qualified with salt iodine(34.6±1.58) mg/kg. A total of 21 107 edible salt samples were tested, and 11 203 of them were qualified iodized salt. These results meant that the provincial iodized salt coverage rate was 53.08%. Shannan iodized salt coverage rate was 94.31% (3395/3600) which was the highest in Tibet. Those of Nagqu, Changdu, Ngari were lower, they were 29.84% (897/3006), 24.94% (823/3300) and 17.08% (205/1200), respectively. Conclusions The quality of iodized salt in Tibet is up to the national standard, but the coverage rate of iodized salt is very low.We suggest that the strategy should be carried out according to the national overall program strategy and supplement iodized oil capsule for special groups.

Objetives To investigate the outcomes of sirolumus-eluting stent(CypherTM,Cordis/Johnson&Johnson,Warren,NJ,USA)and paclitaxel-eluting stent(TaxusTM,Boston Scientific,Natick,MA.USA)in the treatment of coronary heart disease after a four.year clinical follow-up.Methods 237 consecutive patients were enrolled in this study and treated with Cypher(136 patients)or Taxus(101 patients)from January to October 2003.111e rates of stenosis.stent thrombosis according to ARC definition and major adverse cardiac events(MACE a composite of cardiac death,myocardial infarction and target vessel revascularization)were analysed.Results There was no significant difference on secondary restenosis.target lesion revascularization(TLR)and MACE between Cypher and Taxus groups at six.month angiographic follow-up,but late luminal loss was higher in Taxus group[(0.15±0.43)mm vs(0.42±0.34)mm,P=0.022].At four-year follow-up,TVR-free survival rate was 88.97% in Cypher group versus 82.28% in Taxus group(P=0.158).MACE.free survival rate was 83.8% in Cypher group and 79.2% in Taxus group(P=0.056).The incidence of stent tllrombosis was no difference between the two groups(1.47% vs 1.98%).There was also no difference among early(0 vs 0.99%),late(0.73%vs0.99%)and very late stent thrombosis(0.73%vs 0)between the 2 groups.Conlusions There were nodifference between Cypher and Taxus in the treatment of coronary artery disease:Both Cypher and Taxus have good clinical outcomes except that Taxus had highcr late loss.

Objective: To make long-term comparison of drug-eluting stent (DES) implantation betweenleft internal mammary artery (LIMA) graft and native vessel in patients with previous coronary artery bypass grafting (CABG).
Methods: A total of 151 patients with anterior wall ischemia because of previous CABG induced LIMA graft lesion who received percutaneous coronary intervention (PCI) in our hospital from 2004-07 to 2012-12 were retrospectively studied. The clinical, coronaryangiography (CAG) and follow-up conditions for DES implantation were analyzed;according to the target vessel, the patients were divided into 2 groups:LIMA group, n=40 and Native vessel (NV) group, which meant all segments of left main to left anterior descending arteries, n=111. Primary end points included target lesion revascularization (TLR), target lesion failure (TLF) as cardiac death, target vessel related non-fatal MI with the composition of TLR and major adverse cardiovascular events (MACE).
Results:The median follow-up time was 30 (10-100) months. The rates of TLR and TLF were similar between 2 groups:(15.0%vs 11.7%, log-rank P=0.65) and (17.5%vs 13.5%, log-rank P=0.63). MACE occurrence in LIMA group was higher than NV group (35.0%vs 18.0%, log-rank P=0.043) which was mainly presented by new non-target vessel revascularization as right coronary artery, left circumlfex and saphenous vein graft(17.5%vs 4.5%, log-rank P=0.014). Cox multivariate analysis indicated that target lesion stent length was the only independent predictor for both TLR (HR=1.03, 95%CI1.00-1.06, P=0.01) and TLF (HR=1.03, 95%CI1.00-1.05, P=0.02);whereas, LIMA-PCI was the only independent predictor for MACE occurrence (HR=3.09, 95%CI1.28-7.60, P=0.012).
Conclusion: The chances of TLR and TLF were similar inpatients with previous CABG by either LIMA or NV, while MACE occurrence was higher in LIMA patients which should be further investigated.

AIM To prepare silymarin solid dispersions and to evaluate the dissolution rates of five constituents.METHODS Taking F68 and PVPk30 as a combined carrier,the solid dispersions were prepared by solvent fusion method.Then the effects of combined carrier ratio and drug-carrier ratio on dissolution rates of silybin,isosilybin,silydianin,silycristin and taxifolin were investigated.RESULTS The optimal conditions were determined to be 1 ∶ 3 for combined carrier ratio,and 1 ∶ 5 for drug-carrier ratio.These five constituents displayed much higher dissolution rates in solid dispersions than those in raw medicine and physical mixture (silymarin-carrier).CONCLUSION Solid dispersions can significantly increase the dissolution rates of effective components in silymarin.

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
Aged ; Anesthetics, Local ; Brachial Plexus ; Cricoid Cartilage ; Epidural Space ; Female ; Humans ; Male ; Needles ; Shoulder ; Skin ; Spinal Cord ; Upper Extremity

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
Aged ; Anesthetics, Local ; Brachial Plexus ; Cricoid Cartilage ; Epidural Space ; Female ; Humans ; Male ; Needles ; Shoulder ; Skin ; Spinal Cord ; Upper Extremity

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery. But preoperatively administered midazolam may contribute to postopertive sedation and delayed recovery from general anesthesia. This study was undertaken to evaluate the effect of midazolam premedication on postoperative recovery and discharge-readiness after brief outpatient surgery. METHODS: Sixty healthy ASA physical status I women scheduled for outpatient diagnostic laparoscopic surgery were considered for the study. They were randomly allocated to one of two groups. Group one received normal saline (N/S) 5 ml intravenously (IV), while group two received IV midazolam 0.04 mg/kg. The study drug was prepared in 5 ml of saline and administered 10 minutes before the induction of general anesthesia. General anesthesia was induced with fentanyl, propofol and vecuronium and was maintained with N2O and enflurane. Postanesthetic recovery (PAR) scores were recorded after the arrival of the patients in the postanesthetic recovery room. Sedation was quantified before and after premedication and 60, 120 minutes after arriving in the postanesthetic recovery room, using the symbol-digit-modalities test (SDMT) and trail-making test (TMT). RESULTS: There were no significant differences between the two groups with respect to age, weight and anesthesia time. There were no significant differences in PAR scores or PAR-stay time between two groups. SDMT and TMT scores were significantly different 5 minutes after the study's drug administration, and 60 minutes after arrival in the postanesthetic recovery room between the two groups. The incidence of side effects was similar in both groups. CONCLUSIONS: Midazolam premedication proved effective in sedation and anxiolysis without prolonging postanesthetic recovery and discharge times for outpatient general anesthesia.
Ambulatory Surgical Procedures* ; Anesthesia ; Anesthesia, General ; Enflurane ; Female ; Fentanyl ; Humans ; Incidence ; Laparoscopy ; Midazolam* ; Outpatients* ; Premedication* ; Propofol ; Recovery Room* ; Vecuronium Bromide

Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, characterized by sudden cardiovascular collapse, dyspnea or respiratory arrest and altered mentality, disseminated intravascular coagulation (DIC). It can lead to severe maternal morbidity and mortality, but the prediction of its occurrence and treatment are very difficult. We experienced a case of AFE during emergent Cesarean section in a 40(+6) weeks healthy pregnant woman, age 33. Sudden dyspnea, hypotension, signs of pulmonary edema and DIC were developed during Cesarean section, and cardiac arrest followed after these events. The course of these events was so rapid and catastrophic, which was consistent with AFE. Thus, we report this case precisely and review pathophysiology, diagnosis, treatment of AFE by referring to up-to-date literatures.
Amniotic Fluid ; Cesarean Section ; Dacarbazine ; Disseminated Intravascular Coagulation ; Dyspnea ; Embolism, Amniotic Fluid ; Emergencies ; Female ; Heart Arrest ; Humans ; Hypogonadism ; Hypotension ; Mitochondrial Diseases ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Pulmonary Edema