Hepatopulmonary syndrome is a pulmonary syndrome that is characterized by the clinical triad of chronic liver disease,arteriovenous shunts due to intrapulmonary vasodilatation,and arterial hypoxemia.Dwing to its complicated pathogenisis,unconspicuous behavior and lack of clinic features,it is very hard for early diagnosis,so while diagnosed,most of HPS patients are in a hard way.The clinical treatment is limited with unsatisfactory effectiveness,so does the prognosis.This article reviews the current diagnosis and therapies of hepatopulmonary syndrome.

Hepatopulmonary syndrome is the triad of arterial hypoxemia due to pulmonary vascular dilatation induced by liver diseases.The pathogenis' s is complicated.This article reviews the advances of pathogenisis of the disease.

Objective To investigate the impact of 1,25(OH)2D3 on histological changes and activation of STAT3 in BLM?induced pulmonary fibrosis mice. Methods 30 male C57BL/6 mice were randomly divided into control group ,BLM group and BLM+VD group. Mice in BLM group and BLM+VD group received intratracheal injection of BLM(3 U/kg). Control group were intratracheally injected equal volume of sterile saline. From the first day after the surgery,mice in BLM+VD group received intraperitoneal injection of VD (5μg/kg·d). After 21 days, H&E and Masson′s trichrome staining were carried out. Aschroft score were used to evaluate histological changes in lungs. IL?6,IL?4 and INF?γin BALF were assessed by Elisa. p?STAT3,α?SMA and Collagen I were detected by western blot (WB) and immunohistochemistry. Results Fibrosis score and level of α?SMA,Collagen I in BLM group were significantly higher than that in control group (P < 0.05). However ,treatment with VD effectively at?tenuated fibrosis (P<0.05). IL?6 and IL?4 increased while INF?γwas decreased in BALF of BLM group (P<0.05). VD could ameliorate these changes. Upregulation and neuclear translocation of p?STAT3 were observed in BLM group,while VD intervention could inhibit phosphorylation of STAT3. Conclusions VD attenuate BLM?induced pulmonary fibrosis and regulate inflammatory cytokines probably by blocking STAT3 activation.

Objective To explore the role of MKK34 (a peptide spanning a C-terminal α-helical region in TSLP) on airway inflammation and β-catenin of airway epithelium in a HDM-induced mouse asthma.Methods 32 male BALB/c mice were randomly divided into control,MKK34,asthma and MKK34 + HDM groups.The mice in the asthma group were exposed to HDM for five consecutive days and the MKK34 + HDM group was pretreated with MKK34 1 h prior to the HDM intranasally treated.After 8 weeks' treatment,animal lung function test and pathological staining were performed to evaluate the asthma situation,IL-4,IFN-γin bronchoalveolar lavage fluid and IgE in the serum were detected,immunohistochemistry and western blot were used to assess β-catenin and p-ERK,t-ERK levels.Results Airway reactivity,IL-4 and IgE in the asthma group were significantly higher than that in the control group.Treatment with MKK34 significantly decreased airway hyperresponsiveness,IL-4 and IgE.HE staining demonstrated the chronic bronchitic inflammation in the lungs of asthma group.β-catenin in the control group was distributed evenly at the cytomembrane of epithelial cells.In the asthma group,β-catenin was disordered in epithelial cells and its expression was decreased.Treatment with MKK34 ameliorated the damage of β-catenin and chronic bronchitic inflammation.The protein levels of p-ERK1/2 increased obviously in the asthma group.The pretreated group significantly decreased the expression of p-ERK1/2.Conclusions MKK34 can ameliorate the airway inflammation and the destruction of β-catenin of airway epithelium in a HDM-induced mouse asthma.The ERK pathway may play a role in this process.

Objective:To detect the expression of iNOS and nNOS in delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and their correlation with hippocampal neuron degeneration and necrosis, and to explore iNOS and nNOS in DEACMP.Methods:Seventy-two adult male SD rats were selected and randomLy(random number) divided into the DEACMP group and normal group, with 36 rats in each group. The rats were given intraperitoneal injection of 99.99% CO gas without intervention. According to different time periods before and after dying and modeling, the two groups were divided into 6 subgroups: pre-modeling, 1 d modeling, 7 d modeling, 14 d modeling, 21 d modeling, and 28 d modeling. In 6 subgroups during the modeling time, HE staining was performed to observe neuron degeneration and necrosis in hippocampal CA3 area, and immunohistochemistry and Western blot were performed to detect the protein expression of iNOS and nNOS in hippocampus. Statistical analysis was performed using SPSS 21.0 software. The measurement data were expressed as Mean±SD, and normality test and variance analysis were performed on the experimental results of each group. The mean comparison between each group adopted the Student’s t test of two independent samples. Correlation analysis was conducted between the relative expression of iNOS and nNOS protein and the degenerative necrotic neurons, Pearson correlation analysis was used for normal distribution, and Spearman rank correlation analysis was used for non-normal distribution. A P<0.05 was considered as statistically significant. Results:There was no significant difference in the counts of hippocampal neuron degeneration and necrosis between the two groups before modeling, on 1 d, and 7 d modeling ( P>0.05), while there were significant differences between the two groups on 14 d, 21 d, and 28 d modeling ( P<0.05). There was no statistically significant difference in the expression of nNOS protein between the two groups of rats before modeling, on 21 d, and 28 d modeling ( P>0.05), while there were statistical differences between the 1 d modeling, 7 d modeling, and 14 d modeling ( P<0.05). There was no statistically significant difference in the expression of iNOS protein between the two groups of rats before and 1 day after modeling ( P>0.05), while there were statistically significant differences between the 7 d modeling, 14 d modeling, 21 d modeling and 28 d modeling ( P<0.05). Correlation analysis between the expression of iNOS protein and the count of degenerated and necrotic neurons showed a positive correlation ( P<0.05). There was no correlation between the expression of nNOS protein and the count of degenerated and necrotic neuron ( P>0.05). Conclusions:iNOS plays an important role in the pathogenesis of DEACMP; nNOS is not consistently highly expressed in the hippocampus of DEACMP, and has no correlation with neuronal degeneration and necrosis in the CA3 region of the hippocampus.

Objective:To establish and validate a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices of liver cirrhosis.Method:This study retrospectively collected the clinical data of patients with esophageal and gastric variceal bleeding who were admitted to the emergency department of Ningxia Medical University General Hospital from October 2019 to October 2022. The patients were divided into modeling group and validation group according to the ratio of 7:3 by random number table method. The observation index was whether the upper gastrointestinal bleeding occurred within 24 hours after admission. The predictors in the logistic regression model were used to construct a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices with liver cirrhosis, and the area under the receiver operating characteristic curve (AUC), the correction curve and the decision curve were analyzed to evaluate the discriminatory ability, accuracy and clinical utility of the prediction model.Results:A total of 305 patients were included, including 215 and 90 in the modeling and validation groups, respectively, and the clinical data of the two groups were comparable. Multivariate logistic regression showed that systolic blood pressure ( OR=0.918, 95% CI: 0.860-0.980, P=0.010), MAP(ASH) score ( OR=1.993, 95% CI: 1.017-3.907, P=0.045), Child-Pugh score ( OR=1.999, 95% CI: 1.139-3.510, P=0.016) and model for end-stage liver disease (MELD) ( OR=1.398, 95% CI: 1.037-1.886, P=0.028) were independent influencing factors for the occurrence of upper gastrointestinal bleeding in patients with liver cirrhosis varices. The AUC of the prediction model in the modeling group was 0.936 (95% CI: 0.895-0.976), and that of the prediction model in the validation group was 0.891 (95% CI: 0.807-0.975), the prediction model had good identification, calibration, and clinical application value. Conclusions:Systolic blood pressure, MAP (ASH) score, Child-Pugh score, and prediction models constructed by end-stage liver disease models are helpful for early prediction of the risk of upper gastrointestinal bleeding in patients with cirrhosis varices in the emergency department.

OBJECTIVE: To evaluate the effect of the combined application of dissociate skin flap and vacuum sealing drainage (VSD) for the repairing for defect after surgical management of huge neck neoplasms. METHOD: Nineteen patients with huge neck malignant tumor involving the skin of the neck were given radical operation, making use of VSD covering the wound surface. After giving 6.65-7.98 mm Hg continuous negative pressure drainage for 72 h, the patients turned to be treated by intermittent negative pressure therapy with 2 min free interval after each treatment period for 5 min. After dismantling the VSD at 7th to 10th day postoperatively, the good wounds covered by granulation tissue were treated by the skin graft operation with dissociate skin flap from thighs; as for the wounds of which the granulation tissue didn't grow well and important cervical tissues was not fully covered by the granulation tissue, VSD was applied again for 1 week, followed by the skin graft operation. RESULT: Nineteen patients have received a total of 23 times of VSD wound treatment, one-stage operation time was significantly shortened. The granulation tissue grew faster on the wound after VSD treatment, and the important cervical tissues such as great vessels could be well covered. The infection and tumor recurrence were observed directly after dismantling the VSD. The skin graft transplantation would be performed after 1-3 weeks. CONCLUSION The treatment by vacuum sealing drainage combined with skin graft for surgical wounds of huge neck tumor postoperatively has the advantages of simple operation, little injury and promotion of the wound healing, which is an effective way for treatment of neck skin defect by surgical operation for the huge tumor.
Adult ; Aged ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Skin Transplantation ; methods ; Soft Tissue Injuries ; etiology ; surgery ; Surgical Flaps

OBJECTIVETo study the signaling pathways associated with lipopolysaccharide (LPS)-induced inflammation in islet micro-endothelial cells (IMECs) and the mechanism of pravastatin intervention.

METHODSIMECs exposed to LPS, SB203580, pravastatin, or SB203580+pravastatin were examined for cell apoptosis with Hoechst staining and flow cytometry and for expression levels of total-p38, photophosphorylation-p38 (p-p38) and iNOS with Western blotting.

RESULTSThe apoptosis rate and expression levels of total-p38, p-p38, iNOS in IMECs all increased after LPS exposure. Pravastatin, SB203580, and their combination significantly attenuated LPS-induced enhancement of cell apoptosis and total-p38, p-p38, and iNOS expressions in IMECs.

CONCLUSIONLPS-induced inflammatory toxicity in IMECs is associated with the activation of P38MAPK and iNOS/NO signaling pathways. Pravastatin can inhibit these pathways and suppress the apoptosis and necrosis of IMECs to relieve the cell inflammatory injuries.

Animals ; Apoptosis ; Endothelial Cells ; drug effects ; metabolism ; Endothelium, Vascular ; cytology ; Inflammation ; Islets of Langerhans ; blood supply ; MAP Kinase Signaling System ; drug effects ; Mice ; Nitric Oxide Synthase Type II ; metabolism ; Phosphorylation ; Pravastatin ; pharmacology ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective:To observe the relationship between inducible carbon monoxide synthase (iNOS) and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP), and explore its mechanism of action in DEACMP.Methods:This study was designed as prospective cohort study. Patients with acute carbon monoxide poisoning who met the diagnostic criteria and were admitted to Emergency Intensive Care Unit(EICU) of our hospital from June 2019 to June 2021 were selected as subjects. Patients were divided into the DEACMP group and non-DEACMP group according to the occurrence of DEACMP. Serum samples were collected on the first 24 h after admission and on day 7 and 14 after admission, and the serum nitric oxide (NO), neuronal nitric oxide synthase (nNOS), inducible carbon monoxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) level were measured by enzyme-linked immunosorbent assay. The generalized estimating equation was used to estimate the difference of NO, nNOS, iNOS and eNOS between DEACMP and non-DEACMP patients.Results:A total of 78 patients with carbon monoxide poisoning were included in our study finally, including 49 (62.82%) males and 29 (37.18%) females, with an average age of (53.96±14.95) years, 20 (25.64%) patients with DEACMP, and 1 (1.28%) death. Univariate analysis showed that patients with DEACMP had an average increase of 3 h (95% CI: 1.00, 5.00) in carbon monoxide exposure time and a 5-point decrease in GCS score (95% CI: 1.00, 6.00) than the patients without DEACMP, and the proportion of patients with severe carbon monoxide poisoning in the DEACMP group was higher than that of the non-DEACMP group (90.00% vs. 32.76%). According to the analysis of generalized estimation equation, on day 7 and 14 after admission, Compared with non-DEACMP patients, neither by performing unadjusted nor adjusted analysis with the iNOS of DEACMP patients was significantly higher than that in non-DEACMP patients regardless of whether exposure time, GCS score, coma time or severity of carbon monoxide poisoning were adjusted or not ( P <0.01 or P <0.05). Except for the level of nNOS in the GEE model adjusted with carbon monoxide exposure time, the levels of NO, nNOS and eNOS showed no significant difference between DEACMP and non-DEACMP patients ( P >0.05). Conclusions:The expression of iNOS level is increased in DEACMP patients, and its continuous expression may be involved in the pathogenesis of DEACMP.

Objective To investigate the reasons for the inconsistent results between the vertical auto profile(VAP)method and bio-chemical homogeneous phase(BHP)method in detecting plasma low-density lipoprotein cholesterol(LDL-C),and provide experimen-tal basis for the accurate and quantitative detection of plasma LDL-C levels.Methods A total of 360 plasma samples from diabetes mellitus patients combined with carotid plaque admitted to the Department of Endocrinology of Ningbo Yinzhou Hospital of Traditional Chinese Medicine during January,2022 and January,2023 were collected.The LDL-C levels of these samples were detected by the VAP method and BHP method,respectively.The VAP method uses software to automatically calculate the area under the LDL-C curve after centrifugation of the sample as the LDL-C level(LDL-CVAP)and the BHP method directly detects the LDL-C level(LDL-CBHP)by the special surfactant method.360 samples were divided into the consistent group(group A)and inconsistent group(group B)ac-cording to the relative deviation between the LDL-CBHP and LDL-CVAP methods.Group B was further divided into the LDL-CBHP on the high side group(Group B1)and LDL-CBHP on the low side group(Group B2).Groups B1 and B2 were divided into B1-1,B1-2,B1-3 and B2-1 groups based on the degree of relative deviation.The percentages of samples and levels of lipoprotein a cholesterol[Lp(a)-C],intermediate-density lipoprotein cholesterol(IDL-C),Lp(a)-C and IDL-C[Lp(a)-C+IDL-C],very low-density lipo-protein cholesterol(VLDL-C),total cholesterol(TC)and total triglyceride(TG)in each group were compared.Results The LDL-CBHP levels of 360 samples were significantly higher than that of LDL-CVAP(P＜0.01).The percentage of samples in group B was significantly higher than that in group A,and that of group B1 was significantly higher than that of group B2(P＜0.05).The levels of Lp(a)-C,IDL-C and Lp(a)-C+IDL-C in groups B1-1,B1-2,and B1-3 were significantly higher than those in group A(P＜0.01).The relative deviation between LDL-CBHP and LDL-CVAP in 360 samples was significantly positively correlated with the levels of Lp(a)-C,IDL-C,and Lp(a)-C+IDL-C(P＜0.01).The maximum correlation coefficient was found in Lp(a)-C+IDL-C.Conclusion The results of plasma LDL-C in diabetes mellitus patients combined with carotid plaque detected by the BHP method are significantly different from those detected by the VAP method,which mainly shows that the results of the BHP method are on the high side.The higher the level of plasma Lp(a)-C+IDL-C,the greater the relative deviation between the BHP method and VAP method.The reason for the high results of LDL-C detected by the BHP method may be related to the fact that LDL-CBHP contains irremovable Lp(a)-C and cholesterol carried by IDL-C.The VAP method can be used as an accurate method for detecting real LDL-C without Lp(a)-C and IDL-C.