Objective To investigate the correlation between the percentage of systolic stenosis of the mural coronary artery (MCA) and the length and depth of the myocardial bridge using dual-source computed tomography (DSCT). Methods Four hundred and fifty patients suspected of coronary artery disease (CHD) underwent dual-source computed tomography coronary angiography (DSCTCA). The images were analyzed by 2 radiologists independently. When consistency was obtained among the independent results, the diagnosis of MB-MCA could be confirmed. The length of MCA and depth of MB were measured. All data were reconstructed by every 5% R-R interval, the diameters of MCAs during the whole cardiac cycle were reviewed and measured, the phases were detected when the diameters of MCAs were maximal and minimal, the systolic stenosis rate of MCA was calculated,Pearson correlation analysis was used to analyze the relation between length, depth, and degree of systolic stenosis of the MCAs. Results One hundred and ninety-two sites of MB-MCA were found in 163 ( 36. 2% ) of 450 patients. Of the 192 sites, 72 were completely surrounded by myocardium. Among the 30 MCA sites chosen from these 72 sites, the minimal diameters were found at 30%--35% R-R reconstruction interval in 27 sites(90.0% ), and the maximal diameters were found at 70%--80% R-R reconstruction interval in 27 sites (90. 0% ). A significant correlation was not found between systolic stenesis and the length of the MB ( r = 0. 096, P > 0. 05 ) but was found with the depth of the MB ( r = 0. 675, P < 0. 01 ) of the MCA. Conclusion The minimal and maximal diameters of the MCA usually emerged in 30%--35% R-R reconstruction interval and 70%---80% R-R reconstruction interval on DSCTCA, respectively. The degree of systolic stenosis of MCA significantly correlates with MB depth but not length.

Objective To investigate gene polymorphisms of drug targets and mutations associated with drug resistance in Pneumocystis jiroveci (P.jiroveci) isolates.Methods Among 148 samples isolated from human immunodeficiency virus (HIV)infected patients with pneumonia in Guangdong,mitochondrid larg subunit rRNA (mtLSUrRNA) gene was amplified from 51 samples.Dihydropteroate synthase (DHPS),dihydrofolate reductase (DHFR) and Cytochrome b (CYB) genes of P.jiroveci were detected by gene sequencing,and compared with the reference sequences in GenBank to evaluate gene polymorphisms.Results P.jirovecii DHPS,DHFR and CYB genes were all successfully amplified from 51 samples.For DHPS gene,48 (94.1％) were wild-type and 3 (5.9％) had gene mutation associated with drug resistance.For DHFR gene,30 were wild-type,and 21 had a synonymous mutation at position 312,and 1 nonsynonymous mutation at position 188.There were no mutations associated with drug resistance.For CYB gene,polymorphisms of were detected at 5 sites,4 of which were synonymous mutations,1 was non-synonymous mutation.No mutation associated with drug resistance was found.Based on the gene polymorphism of CYB6,the strains can be classified into 6 genotypes,and 2 were first detected,including 25 CYB1,13 CYB2,2 CYB5,4 CYB8,as well as newly detected 4 CYB10 and 3 CYB11 strains.Conclusions The mutations associated with drug resistance in P.jiroveci isolates in Guangdong remain uncommon.CYB gene shows gene polymorphisms and can be selected as one of targeted genes for multilocus sequence typing.

Objective To discuss normalized safety management of using narcotic and psychotropic drugs with high flow rate in large scale operating rooms.Methods The whole process of drugs using and management in every details were consummated by utilizing flow sheet with fineness management,and regulations were optimized gradually through quality control periodically.Results Safety management of using narcotic and psychotropic drugs in our anesthesia and operation center had been realized and got affirmations and high reputations in the inspections of hospital and entire army at different levels.Conclusions Normalized safety management of using narcotic and psychotropic drugs with high flow rate in large scale operating rooms could be realized efficiently by using flow-sheet with fineness management.

Objective To discuss the method and measures of high-quality nursing service in the postanesthesia care unit.Methods Many methods were adopted,that carried out the whole without aperture (holistic) nursing in the anesthesia recovery period,set up specialized nursing quality check list of PACU,strengthened the body and mind warm service,made nurse-patient communication card,paid attention to the five key links in the anesthesia recovery period,and used optimized of nursing documents writing and other new nursing measures.Results The degree of satisfaction among patients and anesthesiologists was significantly improved after the high-quality nursing service was implemented.And no nursing error,accident,and complaints occurred.Conclusions The implementation of high-quality nursing service will be beneficial to meeting the target:“ satisfy the patients,the society and the government”.

BACKGROUNDCurrently, there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM). We retrospectively analyzed the efficacy and safety of two intensive insulin therapy regimens administered to bone fracture patients with T2DM in the perioperative period, to explore the best method of achieving perioperative glycemic control.

METHODSA number of 159 bone fracture patients with T2DM were divided into two groups. One group (n = 81) received multiple subcutaneous insulin injections (MSII group) and the other (n = 78) received continuous subcutaneous insulin infusion (CSII group). Blood glucose (BG) levels, time to achieve glycemic target, insulin dosage, and the incidence of hypoglycemia and complications were compared between groups.

RESULTSBoth regimens reduced BG to desired levels before surgery. The time to reach glycemic target in CSII group (2.5 days) was significantly shorter than that in the MSII group (7.3 days; P < 0.001). Mean insulin dosage in the CSII group (0.66 IU×kg(-1)×d(-1)) was significantly lower than that in the MSII group (0.74 IU×kg(-1)×d(-1); P = 0.005), as were the incidences of hypoglycemia (15.4% vs 32.1%) and infection (6.4% vs. 23.5%). Multiple regression analysis showed that the time to reach glycemia target was associated with the insulin therapy regimen and dosage. The insulin dosage on reaching glycemia target was positively associated with body mass index (BMI), diabetes mellitus course, glycated hemoglobin A1c (HbA1c), and β-hydroxybutyric acid, and was negatively associated with age.

CONCLUSIONThe efficacy and safety of CSII was superior to that achieved with MSII, suggesting that CSII should be considered as initial therapy to control perioperative BG in bone fracture patients with T2DM.

Adult ; Aged ; Blood Glucose ; analysis ; Body Mass Index ; Diabetes Mellitus, Type 2 ; drug therapy ; Female ; Fractures, Bone ; blood ; Glycated Hemoglobin A ; analysis ; Humans ; Insulin ; administration & dosage ; Male ; Middle Aged ; Perioperative Period ; Regression Analysis ; Retrospective Studies

Total saponins of Panax notoginseng (PNS) have been shown to ameliorate renal interstitial fibrosis. Ginsenoside Rg1, a panaxatriol saponin, is one of the major active molecules from PNS. The present study was undertaken to investigate the effect of ginsenoside Rg1 on renal fibrosis in rats with unilateral ureteral obstruction (UUO). The rats were randomly divided into 3 groups: sham-operation (n=15), UUO (n=15) and UUO with ginsenoside Rg1 treatment (n=15, 50 mg per kg body weight, intraperitoneally (i.p.) injected). The rats were sacrificed on Days 7 and 14 after the surgery. Histological examination demonstrated that ginsenoside Rg1 significantly inhibited interstitial fibrosis including tubular injury as well as collagen deposition. alpha-smooth muscle actin (alpha-SMA) and E-cadherin are two markers of tubular epithelial-myofibroblast transition (TEMT). Interestingly, ginsenoside Rg1 notably decreased alpha-SMA expression and simultaneously enhanced E-cadherin expression. The messenger RNA (mRNA) of transforming growth factor-beta1 (TGF-beta1), a key mediator to regulate TEMT, in the obstructed kidney increased dramatically, but was found to decrease significantly after administration of ginsenoside Rg1. Further study showed that ginsenoside Rg1 considerably decreased the levels of both active TGF-beta1 and phosphorylated Smad2 (pSmad2). Moreover, ginsenoside Rg1 substantially suppressed the expression of thrombospondin-1 (TSP-1), a cytokine which can promote the transcription of TGF-beta1 mRNA and the activation of latent TGF-beta1. These results suggest that ginsenoside Rg1 inhibits renal interstitial fibrosis in rats with UUO. The mechanism might be partly related to the blocking of TEMT via suppressing the expression of TSP-1.
Actins ; biosynthesis ; Animals ; Cadherins ; biosynthesis ; Collagen Type I ; genetics ; metabolism ; Fibronectins ; genetics ; metabolism ; Ginsenosides ; pharmacology ; Immunohistochemistry ; Male ; Nephritis, Interstitial ; drug therapy ; genetics ; metabolism ; pathology ; Panax notoginseng ; chemistry ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Smad2 Protein ; biosynthesis ; Thrombospondin 1 ; biosynthesis ; genetics ; Transforming Growth Factor beta1 ; biosynthesis ; genetics ; Ureteral Obstruction ; metabolism ; pathology

AIM:To explore the effect of acteoside on behavioral changes and endoplasmic reticulum stress(ERS)in prefrontal cortex of depressive rats.METHODS:Sprague-Dawley(SD)rats(n=108)were randomly divided into 6 groups:control group,model group,fluoxetine(20 mg/kg)group,low-dose(30 mg/kg)acteoside group,medium-dose(60 mg/kg)acteoside group and high-dose(120 mg/kg)acteoside group,with 18 rats in each group.The depres-sive-like rat model was established by chronic unpredictable mild stress(CUMS)combined with solitary way for 28 d.The rats in fluoxetine group and acteoside groups were treated with fluoxetine(20 mg/kg)or acteoside(30 mg/kg,60 mg/kg and 120 mg/kg)once daily by intragastric administration for 3 weeks.The rats in control group and model group were both given equal volume of saline by intragastric administration for 3 weeks.The behavioral changes were detected by the open-field test and sugar preference experiment.The protein expression of glucose-regulated protein 78(GRP78 )and C/EBP homologous protein(CHOP)was assessed by immunofluorescence and Western blot.The caspase-3 activity was measured by spectrophotometer.RESULTS:Compared with control group ,the total distance ,time spent in the center and sugar in-take were all decreased ,the expression of GRP78 and CHOP was increased ,and the activity of caspase-3 was increased in model group ,fluoxetine group and acteoside groups(P<0.05 ).Compared with model group ,the total distance ,time spent in the center and sugar intake were increased ,the expression of GRP78 and CHOP was reduced ,and the activity of caspase-3 was decreased(P<0.05)in fluoxetine group and acteoside groups.CONCLUSION:Acteoside improves de-pressive-like behaviors in depressive rats ,which may be related to the inhibition of ERS and neuronal apoptosis in prefron-tal cortex.

OBJECTIVETo investigate the effect of transforming growth factor beta (TGF-beta) on ectomesenchymal stem cells differentiating to smooth muscle cells.

METHODS60 pmol/L TGF-beta was added to the ectomesenchymal stem cells of embryonic facial processes. Immunohistochemistry assay and image analysis were used to value the expression extent of a smooth muscle actin (alpha-SMA) and quantitative RT-PCR was used to value the quantity of alpha-SMA.

RESULTS2 days later, about 95% cells in TGF-beta group and 65% cells in control group without differentiation inhibitor expressed alpha-SMA. Expression of alpha-SMA in TGF-beta group was stronger than that of control group after one and two days. Quantitative RT-PCR showed the quantity of alpha-SMA mRNA in treated group cells was more than that of in control group.

CONCLUSIONQuantity of alpha-SMA in TGF-beta group is more than that of spontaneous differentiation group. TGF-beta has positive effect on ectomesenchymal stem cells differentiating to smooth muscle cells.

Actins ; metabolism ; Cell Differentiation ; drug effects ; Cells, Cultured ; Humans ; Mesenchymal Stromal Cells ; cytology ; drug effects ; Myocytes, Smooth Muscle ; cytology ; drug effects ; Transforming Growth Factor beta ; pharmacology

OBJECTIVETo summarize experience of pediatric intensive care and explore the incidence of complications, the involved pathogens among liver recipients to determine the effective strategies for preventing complications.

METHODSBetween June 2006 and July 2009, 35 children under the age of 14 yr received 35 liver transplantations (LTs) performed at the center. A retrospective review of 22 infants weighing 8.8 kg or less underwent 23 transplants was conducted. Indication for transplantation was biliary atresia. Central venous pressure and arterial blood pressure were monitored continuously and fluid monitoring was performed every 2 hours in the first postoperative week. Blood loss, ascites, and intraoperative transudate loss were primarily replaced with 5% albumin and crystalloids to maintain a central venous pressure between 4 and 6 cm H(2)O. Oral food intake was allowed as soon as possible. To identify vascular or biliary complications, liver doppler ultrasound was performed intraoperatively immediately after reperfusion and after closure of the abdominal wall and postoperatively, twice daily during the first week after surgery. Immunosuppression was initially cyclosporine based, in combination with steroids. Cyclosporine was begun one day prior to transplantation at a dose of 10 mg/(kg·d) divided into two doses, except for cases with hepatic encephalopathy and severe infection. The subsequent doses were adjusted on the basis of recommended trough blood concentrations at different stages. Steroids were eventually discontinued at a time point exceeding 6 months after transplantation. The diagnosis of rejection was confirmed by histology on needle biopsy specimens. Acute graft rejection episodes were treated with a 3-day scheme of IV methylprednisolone 10 mg/(kg·d) followed by recycling doses during the following 3 days (7.5, 5 and 2.5 mg/(kg·d).

RESULTSThe most common postoperative complications were infections (18 cases), gastrointestinal bleeding (3 cases), and vascular complications (4 cases). Rejection occurred in 25% of patients. There was one perioperative death from primary graft non-function. The most common isolated bacteria of the pathogen spectrum were Staphylococcus epidermidis. The median length of stay (LOS) in the PICU for 22 patients (23 transplants) was 10 days (range 5 - 21) and the mean length of stay in the hospital was (18.5 ± 116) days (range, 11 - 48 days). Mean requirement for artificial ventilation was 37.6 h. Mean use of dobutamine, prostaglandin E1 and dopamine was 3.3, 7.5 and 8.8 days, respectively. Preoperatively, 3 children had gastrointestinal bleeding, 18 had ascites, 2 had encephalopathy, 22 had jaundice, and 16 had coagulopathy. There were multiple early operative complications in these infants, including one graft with primary non-function (4.5%). Two patients (9.1%) returned for a total of three times for gastrointestinal bleeding or intra-abdominal hematoma. Three patients (13.6%) had early postoperative intestinal perforations related to adhesions or enterotomy, one was associated with a bowel obstruction. There were 26 episodes of bacterial or fungal infections in 18 (81.8%) patients in the early postoperative period, and infection was the direct/contributing cause of death in one infant. These infections included pneumonia, intra-abdominal abscess or sepsis. All of the bacterial and fungal infections were successfully treated with the appropriate antibacterial and antifungal agents, except for one patient who developed overwhelming sepsis after small bowel perforation. Four (18.2%) patients developed five episodes of acute allograft rejection during the first 15 days after LT. Three of the four patients who developed rejection were transplanted before 2007. All episodes of rejection were treated successfully with intravenous steroid pulse and optimization of cyclosporine levels or FK506 conversion. Of the 20 survivors beyond the perioperative period, two cases (10%) had hypertension requiring therapy.

CONCLUSIONSLiver transplantation in infants with biliary atresia appears technically demanding but acceptable. There should be essentially no age or size restriction for infants and transplantation can be performed with good outcome, although the frequency of complications is much higher than that seen in older children. The improvement in medical and nursing expertise in this group of very sick infants is based on judicious preoperative donor and recipient selection, meticulous surgical technique (vascular reconstruction and abdominal closure), immediate detection and prompt intervention of complications, and keen postoperative surveillance, which reflect a learning curve for both the technical aspects of liver transplantation and post-operative care of these very small patients in our institution. Liver transplantation for infants can be technically challenging.

Biliary Atresia ; surgery ; therapy ; Child, Preschool ; Critical Care ; methods ; Humans ; Infant ; Liver Transplantation ; Living Donors ; Parenteral Nutrition ; Postoperative Care ; methods ; Retrospective Studies ; Treatment Outcome

Gene recombination can occur during the evolution of endophytes isolated from Glycyrrhiza uralensis,so pharmacological action and active ingredients of endophytes is identical or similar to its hosts.To explore this them will help resolve situation shortage of Glycyrrhiza resources,open a new approach for medicinal licorice resource.The article reviews the progress of variety,identification,pharmacological action and active ingredients of endophytes from Glycyrrhiza uralensis,offers some reference to deep research and development of it.