Objective To analyze the risk factors of mortality in hospitalized patients with peptic ulcer bleeding (PUB).Methods From January 2003 to December 2012,1 210 patients with PUB were collected.Among them,1 170 patients were cured (cured group) and 40 patients died (dead group).The general information and clinical data of patients were collected,which included gender,age,smoking history,non-steroidal anti-inflammatory drugs intake,haematemesis,shock,blood infusion and rebleeding.The information of patients combined with other diseases was also collected.The lab findings and gastroendoscopy findings were also collected,including hemoglobin,platelets,serum albumin,blood urea nitrogen,serum creatinine levels,coagulation,location of ulcer and Forrest classification.Chi-square test was performed for comparison between groups of count data.The t-test was used for comparison between groups of measurement data and normally distributed,and Mann-Whitney rank sum test was used for non-normal distribution.The risk factors of mortality of patients with PUB were analyzed by univariate and multivariate Logistic regression analysis.Results The rates of age over 65,combined with other diseases,shock,rebleeding,abnormal coagulation,Forrest classification above Ⅱ b,medicine spraying to stop bleeding under gastroendoscope,gastroendoscopic hemostasis with titanium clip and operation of dead group (57.5％,23/40; 27.5％,11/40; 25.0％,10/40; 42.5％,17/40; 25.0％,10/40; 35.0％,14/40; 15.0％,6/40; 12.5％,5/40 and 17.5％,7/40) were all higher than those of cured group (25.0％,293/1 170; 7.4％,86/1 170; 12.5％,146/1 170; 13.1％,153/1 170; 5.1％,60/1 170; 20.9％,244/1 170; 4.8％,56/1 170; 4.1％,48/1 170 and 6.5％,76/1 170).The differences were statistically significant (x2 =21.117,18.651,5.400,27.728,9.203,4.613,6.332,4.661 and 5.710,all P＜0.05).The serum albumin level of dead group ((28.71±7.13) g/L) was lower than that of cured group ((32.82±7.55) g/L) and the difference was statistically significant (t=2.215,P＜0.05).Between the groups,there were no significant differences in gender distribution,rate of patients smoking,rate of patients taking non-steroidal anti-inflammatory drugs,rate of patients with haematemesis,volume of blood infusion,location of ulcer,dosage of proton pump inhibitor (PPI),average hemoglobin level,blood urea nitrogen level,serum creatinine and platelet count (all P＞0.01).Age over 65,combined with other diseases and rebleeding were the independent risk factors of mortality of patients with PUB during hospitalization (OR=4.821,12.959 and9.627,all P＜0.01).Conclusion Age over 65,combined with other diseases and rebleeding are the independent risk factors of mortality of patients with PUB during hospitalization.

Objective To evaluate the role of spinal phosphatidyl-inositol 3-kinase/Akt (PI3k/Akt) signaling pathway in the maintenance of bone cancer pain (BCP) in rats and its relationship with microglial activation.Methods Forty healthy female Sprague-Dawley rats,weighing 180-200 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S) ; PI3K inhibitor LY294002 group (group L) ; group BCP; BCP + dimethyl sulfoxide (DMSO) group (group BCP + D) ; BCP + LY294002 group (group BCP + L).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibia.At 7-9 days after inoculation,LY294002 2.5 μg/10 μl was injected intrathecally in L and BCP + L groups,normal saline 10 μl was injected intrathecally in S and BCP groups,and 5％ DMSO 10 μl was injected intrathecally in BCP+ D group once a day.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before inoculation and 1,3,5,7,8 and 9 days after inoculation.The rats were sacrificed after MWT was measured on day 9 after inoculation and the L4-6 segments of the spinal cord were removed to determinate the activation of spinal microglia using immunofluorescence.Results Compared with group S,MWT was significantly decreased,and the activation of spinal microglia was increased in BCP,BCP + D and BCP+ L groups.Compared with BCP and BCP + D groups,MWT was significantly increased,and the activation of spinal microglia was decreased in BCP + D group.Conclusion Spinal PI3K/Akt signaling pathway is involved in the maintenance of BCP possibly through activating microglia in spinal dorsal horns of rats.

Objective To evaluate the effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred ASA physical status Ⅱ or Ⅲ and NYHA class Ⅰ or Ⅱ patients of both sexes,aged 45-70 yr,weighing 63-82 kg,scheduled for elective OPCABG,were randomly assigned into 4 groups (n=25 each):control group (group C),lidocaine group (group L),sevoflurane group (group S),sevoflurane combined with lidocaine group (group SL).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with iv infusion of propofol and intermittent iv boluses of sufentanil and pipecuronium.Bispectral index value was maintained at 45-55.Lidocaine 1.5 mg/kg was injected after intubation,followed by infusion at 2 mg/min until the end of surgery in L and SL groups.Sevoflurane was inhaled with end-tidal concentration of 2.2％-2.5％ starting from the end of intubation until the end of operation in S and SL groups.Before induction of anesthesia,at skin incision,immediately after transsection of internal mammary artery,after completion of anastomosis of the proximal aortovein and distal coronary artery,at the end of operation and at 24 h during operation,venous blood samples were obtained to detect the levels of plasma creatine kinase (CK),creatine kinase isoenzyme-MB (CK-MB) and cardiac troponin Ⅰ (cTnI).Lidocaine-related side effects such as arrhythmia,bradycardia or cardiac arrest were recorded during operation and within 24 h after operation.Results Compared with group C,the plasma CK,CK-MB and cTnI levels were decreased in the S,L and SL groups.The plasma CK-MB and cTnI levels were significantly lower in SL group than in L group.The plasma CK,CK-MB and cTnI levels were significantly lower in SL group than in S group.In L and SL groups,no patient developed lidocainerelated side effects.Conclusion Lidocaine 1.5 mg/kg injected intravenously after intubation,followed by infusion at 2 mg/min in combination with sevoflurane end-tidal concentration about 2.2％ ～2.5％ provides myocardial protection in patients undergoing OPCABG,the efficacy is stronger than that of either alone.

In order to improve its dispersion condition in dental composite resin and enhance its interaction with the matrix, single-walled carbon nanotubes(SWNTs) were refluxed and oxidized, then treated by APTE. Their outer surface were coated by nano-SiO2 particles using sol-gel process, then further treated by organosilanes ATES. IR and TEM were used to analyze modification results. TEM pictures showed nano-particles were on the surface of SWNTs; IR showed characteristic adsorbing bands of SiO2. Composite resin specimen with modified SWNTs was prepared and examined by TEM. SWNTs were detected in composite resin matrix among other inorganic fillers.
Composite Resins ; chemistry ; Dental Materials ; chemistry ; Humans ; Nanotubes, Carbon ; chemistry ; Resin Cements ; chemistry ; Silicon Dioxide ; chemistry ; Surface Properties ; Tensile Strength

Objective To evaluate the role of c-Jun N-terminal kinase (JNK)/monocyte chemoattractant protein-1 (MCP-1) signaling pathway in the spinal cord in the maintenance of bone cancer pain (BCP) in rats.Methods Fifty female Sprague-Dawley rats,weighing 150-180 g,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S),sham operation + JNK inhibitor SP600125 (group SP),BCP group,BCP + dimethyl sulfoxide (DMSO) group,and BCP+ SP600125 group (group BCP+ SP).BCP was induced by injecting Walker 256 mammary gland cancer cells into the bone marrow of the left tibia.On 10-12 days after BCP,SP600125 10 μg(10 μ1) was injected intrathecally once a day in SP and BCP + SP groups,and 5％ DMSO 10 μl was injected intrathecally once a day in BCP + DMSO group.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before BCP and 3,6,9,10,11 and 12 days after BCP.After measurement of MWT at 12 days after BCP,the rats were sacrificed and L4-6 segments of the spinal cord were removed for determination of MCP-1 expression by using immuno-histochemistry and Western blot.Results Compared with S group,MWT was significantly decreased at 6-12 days after BCP,MCP-1 expression was upregulated in BCP,BCP + DMSO and BCP + SP groups (P ＜ 0.01),and no significant change was found in the parameters mentioned above in SP group (P ＞ 0.05).Compared with BCP group,MWT was significantly increased at 10-12 days after BCP,MCP-1 expression was down-regulated in BCP + SP group (P ＜ 0.01),and no significant change was found in the parameters mentioned above in BCP + DMSO group (P ＞ 0.05).Conclusion JNK/MCP-1 signaling pathway in the spinal cord may be involved in the maintenance of BCP in rats.

Objective To evaluate the clinical value of gemstone spectral imaging (GSI) in preliminary assessment of esophageal carcinoma pathology features.Methods 58 patients were analyzed which were diagnosed with histological pathology as esophageal carcinoma underwent GSI enhanced scans before surgery.The iodine concentrations (IC) in the lesions were measured on the iodine-water based material-decomposition images.The results of IC value were evaluated retrospectively with different pathological grading,locations and pathological morphology according to the final pathologic findings.Results 52 cases patients were squamous cell carcinoma and 6 patients were adenocarcinoma.The IC values were (14.75±4.24) mg/ml and (12.86±5.09) mg/ml.The IC value between the two different pathological types had not statistically difference (P =0.35).The IC of different pathological grading:Well differentiation was (20.08± 4.66)mg/ml,n =19.Medium was (14.13±3.39) mg/ml,n =25.Poor was(11.73±3.21) mg/ml,n =14.The IC values between pathological grading had significant difference(P =0.00).There were four different pathological morphology including m edullar (n =16),m ushroom type (n =21),ulcer (n =13) and narrow type (n =8).Their IC values respectively were (16.34±2.56) mg/ml,(18.70±3.03) mg/ml,(14.31±4.60) mg/ml and (11.18±2.09) mg/ml.The IC value between mushroom and narrow type had statistical difference (P =0.04).The Other types had no statistically difference (P =0.19).Conclusions The results of this study demonstrate that GSI has a certain ability of pathologic stage of esophageal cancer.The GSI has a certain clinical value in guiding treatment and judging prognosis of esophageal carcinoma.

Objective To evaluate the role of spinal microglial C-C chemokine receptor type 2 (CCR2) in the maintenance of bone cancer pain (BCP) in rats.Methods Fifty unmated female Sprague-Dawley rats,aged 2 months,weighing 160-180 g,were randomly divided into 5 groups (n =10 each):sham operation group (group Ⅰ),sham operation + RS102895 (CCR2 antagonist) group (group Ⅱ),BCP group (group Ⅲ),BCP + dimethylsulfoxide (DMSO) group (group Ⅳ),and BCP + RS102895 group (group Ⅴ).The rats were anesthetized with intraperitoneal chloral hydrate.BCP was induced by intra-tibial inoculation of 1 × 105 Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibial metaphysis.On 10-12 days after operation,3 μg/μl RS102895 10 μd was injected intrathecally once a day in Ⅱ and Ⅴ groups,10％ DMSO 10 μl was injected intrathecally once a day in Ⅳ group,and normal saline 10 μl was injected intrathecally once a day in Ⅰ and Ⅲ groups.Mechanical paw withdrawal threshold was measured at 1 day before operation and 3,6,9,10,11 and 12 days after operation.After measurement of pain threshold at day 12 after operation,the lumbar segments (L4-6) of the spinal cord were removed for determination of the level of ox-42 (spinal microglial activation marker) (by immuno-histochemistry) and contents of IL1-β,IL-6 and TNF-α (by ELISA).Results Compared with group Ⅰ,mechanical paw withdrawal threshold was significantly decreased at 6-12 days after operation,the number of ox-42 positive cells and contents of IL1-β,IL-6 and TNF-α were increased in Ⅲ,Ⅳ and Ⅴ groups,and no significant change was found in the parameters mentioned above in group Ⅱ.Compared with group Ⅲ,mechanical paw withdrawal threshold was significantly increased at 10-12 days after operation,the number of ox-42 positive cells and contents of IL1-β,IL-6 and TNF-α were decreased in group Ⅴ,and no significant change was found in the parameters mentioned above in group Ⅳ.Conclusion Spinal microglial CCR2 is involved in the maintenance of BCP via activating microglia and promoting the release of inflammatory cytokines of rats.

Objective To evaluate the role of phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway in mild head hypothermia-induced reduction of global cerebral ischemiareperfusion (I/R) injury in rats.Methods Sixty male Sprague-Dawley rats,weighing 250-280 g,were randomly divided into 5 groups (n=12 each) using a random number table:sham operation group (group S),group I/R,mild hypothermia + I/R group (group H),mild hypothermia + I/R + solvent control group (group DM),and mild hypothermia + I/R + PI3K inhibitor LY294002 group (group LY).Global cerebral I/R was induced by modified four-vessel occlusion method described by Pulsinelli.In H group,when the hippocampal temperature was decreased to 33℃ using nasopharyngeal cooling,the bilateral common carotid arteries were occluded for 15 min followed by reperfusion,and hippocampal hypothermia was maintained at 32.5-33.5 ℃ for 1 h.In DM and LY groups,DMSO and LY294002 5 μl were injected into the left ventricle,respectively,and 20 min later the other procedures were similar to those previously described in group H.At 8 h of reperfusion,6 rats were sacrificed,and hippocampal specimens were obtained to detect the expression of pFoxO3a,Bcl-2 and Bax (by immuno-histochemistry).The expression of phosphor-Akt (p-Akt) was determined by Western blot.Results Compared with group S,the expression of p-Akt,pFoxO3a and Bcl-2 was significantly up-regulated in I/R,H and DM groups,the expression of Bcl-2 was down-regulated,and the ratio of Bcl-2/Bax was increased in H and DM groups,and the ratio of Bcl-2/Bax was decreased in I/R and LY groups.Compared with group I/R,the expression of p-Akt,pFoxO3a and Bcl-2 was significantly up-regulated,the expression of Bcl-2 was down-regulated,and the ratio of Bcl-2/ Bax was increased in H and DM groups.Compared with H and DM groups,the expression of p-Akt,pFoxO3a and Bcl-2 was down-regulated,the expression of Bax was up-regulated,and the ratio of Bcl-2/ Bax was decreased in group LY.Conclusion PI3K/Akt signaling pathway is involved in reduction of global cerebral I/R injury by mild head hypothermia in rats.

Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation, by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia, 42 males and 18 females, aged 21-62 years, weighing 43-80 kg, ASA physical status Ⅱ-Ⅳ, were randomly divided into 2 groups: protective mechanical ventilation group (group P) and unprotective mechanical ventilation group (group U).Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points: before operation (T1), 3 hours after mechanical ventilation (T2), 2 hours (T3) and 4 hours in neohepatic stage (T4).These mediators included clara cell secretory protein (CC16), surfactant proteins (SP-D), soluble receptor for advanced glycation end-products (sRAGE), TNF-α, IL-6 and IL-8.Moreover, blood gas results were recorded at these 7 time points: T1-T4, 2 hours after operation (T5), before tracheal extubation (T6) and 2 days after operation (T7).The postoperative awakening time, tracheal extubation time, ICU stay time and the incidence of ALI were recorded.Results Compared with T1, plasma level of CC16 in the two groups increased at T2 and T3 (P<0.05 or P<0.01), however, plasma level of SP-D, sRAGE, TNF-α, IL-6 and IL-8 did not increase until T3 (P<0.01).Moreover, plasma level of sRAGE, TNF-α, IL-6 and IL-8 at T4 were higher than those at T1 (P<0.05 or P<0.01).Compared with T1, OIs in the two groups increased at T2, T5 and T6 (P<0.05 or P<0.01), while decreased at T4 in group P (P<0.01) and at T3 and T4 in group U (P<0.01).In group P, patients showed a lower plasma level of CC16 at T2 and T3 (P<0.05 or P<0.01), a higher OI at T3 (P<0.05) and an earlier tracheal extubation after operation [(8.9±3.2) h vs (9.3±2.8) h, P<0.05] compared with group U.There was no significant difference of acute lung injury incidence between the two groups after operation, which was 5(16.6%) and 7 (23.3%), respectively.Conclusion Protective mechanical ventilation may promote oxygenation index, and shorten tracheal extubation time, thus protect lung function of patients in liver transplantation to some extend.

Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation.Methods Sixty patients of both sexes,aged 21-64 yr,with body mass index of 18-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,scheduled for elective orthotopic liver transplantation,were divided into 2 groups (n =30 each) using a random number table:conventional mechanical ventilation group (group CMV) and lung-protective ventilation group (group LPV).In group LPV,the patients were mechanically ventilated (tidal volume 6-8 ml/kg,respiratory rate 10-15 breaths/min,positive end-expiratory pressure 3-10 cmH2 O),and lung recruitment mnaneuver was pertormed every 2 h.Before skin incision (T1),at 3 h of preanhepatic phase (T2),at 30 min of anhepatic phase (T3) and at 2 and 4 h of neohepatic phase (T4.5),bronchoalveolar lavage fluid (BALF) was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation (T6),before tracheal extubation (T7) and at 2 days after operation (T8),blood samples from the radial artery were collected for blood gas analysis,and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16,surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time,extubation time,duration of intensive care unit stay and development of acute lung injury were recorded.Results Compared with group CMV,the cxtubation time was significantly shortened,serum concentrations of Clara cell secretory protein 16 at T2,T3,T6 and T7,serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation endproducts at T5 and T6 were decreased (P＜0.05),and no significant change was found in tunor necrosis factor-alpha and interleukin-8 concentrations in serum and BALF at each time point or postoperative incidence of acute lung injury,oxygenation index,emergence time and duration of intensive care unit stay in group LPV (P＞0.05).Conclusion Although lung-protective ventilation dose not decrease the development of acute lung injury after liver transplantation,it attenuates lung tissue injury to some extent.