BACKGROUND: Knowing the pathological changes of the lungs after the wallop from the bullet wound helps to improve the method or mean of dealing with the wound or to reduce the damage to lung functions after the wound.OBJECTIVE: To probe into the functional and pathological changes of the lung tissues after bullet wound.DESIGN: Open experimental study of the animals.SETTING: Department of the Integrated Traditional Chinese and Western Medicine, General Hospital of the Chinese People's Armed Police Forces.MATERIALS: The experiment was completed from June 2003 to December 2003 at the General Hospital of the Armed Police Forces. Six healthy grown-up cross-bred dogs, half male and half female, weighing ( 16.3 ± 0.58 ) kg, aged (8 - 12) months old, were provided by the Experimental Animal Center of the Military Academy of Sciences of Chinese PLA. Animal Center's license No. Was SCXK(army)2002-001. The animals were fed with water and food with no restrictions in an environment in which the temperature was 22 to 23 ℃ and the humidity was 74% - 80%.METHODS: Grown-up healthy domestic dogs were shot at the thick muscular part of their left hind legs with a size 81 automatic rifles, 7.62 mm in caliber and bullet of type-560. Caution was taken to avoid damage to the major vessels and the bone tissues. The shooting distance was 5 meters. Immediate hemostasis and bandaging were performed after shooting. And 6 hours later, pathological examination of the lungs was carTied out.MAIN OUTCOME MEASURES: Pathological changes of the lungs.RESULTS: After the bullet wound, the main pathological manifestations of the lungs were detelectasis of the pulmonary alveoli and the decrease of air volume complicated with inflammatory alveoli infiltration, lung edema, obscure structure of pulmonary alveoli, passive congestion of the small blood vessels, etc.CONCLUSION: The lung wound was obvious after bullet wound and its mechanism was associated with stress, inflammatory reaction of the adjacent tissues and far domino effect. Blood rheological changes after the wound were one of the most important factors to affect the microcirculation of the cerebral and lung tissues. It was found that clear blood rheological changes occurred at the earlier stage after the wound, and the chief manifestations included the increase of the whole blood viscosity and the index of the erythrocyte aggregation at the time of low sheering rate. The changes reached their peaks 6hours after the wound. On the one hand, because of the increase of whole blood viscosity and the index of erythrocyte aggregation, stasis of red blood cells might happen. And embolism of micro blood vessels in the brain and lungs would change the microcirculation of the brain and lungs. On the other hand, when serious injury of local tissues happens, the body's stress reaction would be strong and secretion and the release of stress hormones and certain active biological small molecular substances would increase, such as nitrogen monoxide(NO), tumor necrosis factor(TNF), endothelin(ET), etc. Their increase would stimulate the micro blood vessels of the brain and lungs and disturb their diastole and constriction functions. After the wound by high-speed projectile, blood flow volume in the animal's cerebral and lung tissues reduced sharply. The micrangium of the brain and lung dilated, and its diameter increased, which resulted in ischemia and hypoxia of the brain and lung tissues, and therefore edema of the brain and lung tissues and hypofunction of the lungs. Therefore, for the bullet wound of the limbs, in addition to dealing with local damage, the brain, the lungs and other important organs should be protected. This provides a theoretical basis for improving the brain and lung function after the bullet wound.

Objective To evaluate the value of cerebral CT and MRI in prediction of the recovery of comatose patients after severe traumatic brain injury.Methods Cerebral CT and MRI were performed in 98 comatose patients after severe traumatic brain injury. CT and MRI were reviewed by three neuroradiologists for the number, sizes, and location of brain lesions. Three neurologists assessed the patients at admission and 1 month after injury. The correlation among the neuroimaging finding, clinical examination index and the prognosis of the patients was analyzed.Results Clinical characteristics, such as initial score on the Glasgow Coma Scale, age, and pupillary abnormalities failed to predict recovery. Cerebral CT did not predict future recovery from post-traumatic coma. The patients in persistent vegetative state(PVS) revealed a significantly higher frequency of corpus callosum, corona radiate, and dorsolateral brainstem injuries than did patients who recovered within 1 month.Conclusion Cerebral CT findings in the acute stage after head injury can not predict the outcome of the post-traumatic PVS. There is a significant association between MRI findings and PVS: patients in coma with lesions in the corpus callosum, corona radiata or dorsolateral brainstem.

Objective To summarize the clinical efficacy of Millikan's modified modality using tension-free mesh-plug inguinal herniorrhaphy. Methods A retrospective study was performed in 185 cases with in-guinal hernias. They received surgical treatment using Millikan's modality in our hospital from Jan. 2005 to Dec. 2006. Results There were 184 males and 1 female in these patients with a average age of 47 years ( range 32 - 75 years). Among them, 7 cases had bilateral hernia. The mean operative time of each hernia was 49 min (range 30 -70 min), and the average postoperative hospital stay was 5. 1 days (range 3 - 18 d). The complication rate was 10. 8% (20/185). All patients had no recurrence after following-up over 24 months. Conclusion Millikan's modified mesh-plug hemioplasty is a safe and effective modality in the pri-mary inguinal hernia repair, and has fewer complications and lower recurrence rate.

Objective To determine the efficacy of coronary artery bypass grafting (CABG) in children with coronary obstructive disease subsequent to Kawasaki disease. Methods Between Feb 2005 and Sep 2009, 6 children with ischemic heart disease due to Kawasaki disease comprised the study group. The age of patients at operation was ranged from 6 to 12 years with a mean of ( 8.0 ± 2.3 ) years. The preoperative EF was ranged from 0.33 to 0.71 with a mean of 0.57 ± 0.15. There was one case with moderate mitral valve regurgitation. Results All patients survived the procedures. The mean number of bypass graft was 2.0 ±0.6,with 4 internal thoracic arteries and 7 radial arteries. Mitral valve repair was employed in 1 case. The cardisc function ( NYHA and EF) was significantly improved postoperatively. Postoperative CTA showed no graft disease in all cases. Conclusion CABG using the arterial grafts can provide attractive mid-term results in patients with obstructive coronary arteries associated with Kawasaki disease.

[ ABSTRACT] AIM:To investigate the changes of peroxisome proliferator-activated receptors ( PPAR)α/peroxi-some proliferator activated receptor coactivator 1 alpha ( PGC-1α) in doxorubicin ( DOX) induced dilated cardiomyopathy ( DCM) and its effect on the energy metabolism and myocardial function in mice .METHODS:Forty mice were randomly divided into 4 groups:control group, DOX group, PPARαinhibitor group and PPARαagonist group.The DCM model was established by injection of DOX.The protein levels of PPARα/PGC-1αwere detected.The PPARαinhibitor and PPARαagonist were used 2 weeks beforeinjection of DOX.The contents of adenine acid and phosphocreatine ( Pcr) in the mito-chondria were measured by high-performance liquid chromatography ( HPLC) .The ANT activity was analyzed by the atrac-tyloside-inhibitor stop technique.The changes of the echocardiography and hemodynamics were also observed.RESULTS:DOX induced DCM model was successfully established.The protein levels of PPARαand PGC-1αin control group were significantly higher than those in DOX group (P<0.05).Both of the high-energy phosphate contents and the transport ac-tivity of ANT were decreased in DOX group (P<0.05), and the hemodynamic parameters were disordered (P<0.01). Compared with DOX group, PPARαinhibitor pre-treatment significantly reduced the PPARα/PGC-1αexpression.Mean-while, high-energy phosphate contents in the mitochondria and the ANT transport activity of the mitochondria decreased, as well as the left ventricular function ( P<0.05) .On the other hand, PPARαagonist significantly increased the expression of PPARαand PGC-1α, and improved the transport activity of ANT.In addition, the hemodynamic parameters were amel-iorated, but the high-energy phosphate contents of the mitochondria did not significantly change.CONCLUSION:PPARα/PGC-1αplays an important role in the regulation of ANT transport activity in dilated cardiomyopathy induced by DOX, and the activation of PPARα/PGC-1αhas protective effects on the DCM induced by DOX.

Objective To analyze the correlation of vertebral osteophyte and lumbar disc degeneration in the elderly people and explore the possible mechanism of osteophyte formation. Methods X-ray and MRI data of 120 elderly people with backache or leg pain were retrospectively analyzed. Osteophyte was classified into four grades by X-ray according to the method proposed by Nathan. Discs with osteophyte were defined as occurring when osteophyte of grade II or greater were present. Lumbar disc degeneration was classified into five grades by MRI according to the method proposed by Pfirrmann. The obtained parameters were statistically treated and analyzed. Results Osteophyte and age were positively correlated at every lumbar disc level (P < 0.05). The proportion of osteophyte in L3/4 (76.7%) and L4/5 (70.08%) were more severe than that in L1/2 (31.7%) and L2/3 (46.7%). Osteophyte and lumbar disc degeneration were positively correlated at every lumbar disc level (P < 0.01). Conclusion Osteophyte becomes more severe with the increasing of lumbar disc degeneration. The vertebral stress after lumbar disc degeneration may be the main cause of osteophyte.

Objective To investigate the relationship of complements C3 and C4 with essential hypertension and its risk factors, homocysteine (HCY) and blood lipids.Methods We selected 20 healthy subjects for physical checkup as control group and 45 patients with hypertension as hypertension group.According to The Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults, the hypertension group was divided into lipid regulating therapy group and non-lipid regulating therapy group.We determined the levels of complements C3 and C4, HCY, total cholesterol, low density lipoprotein and apolipoprotein.Pearson linear correlation regression analysis was used to analyze the correlation of the complements with HCY and blood lipid indexes.Results Complements C3 and C4 were significantly higher in the hypertension group than in the control group (P<0.05).HCY was also significantly higher than that in control group (P<0.05).The Pearson linear correlation analysis showed that in the hypertension group Complement C3 was positively correlated with cholesterol, low density lipoprotein and apolipoprotein B (P<0.05).Complements C3 and C4 were not related to HCY (P=0.073, P=0.699).Compared with the non-lipid regulating therapy group, C4, cholesterol, low density lipoprotein and apolipoprotein B were significantly decreased in the lipid regulating therapy group (P<0.05).The Pearson linear correlation analysis showed that in the lipid regulating therapy group complements C3 and C4 were not related to low density lipoprotein (P>0.05) or to homocysteine (P=0.074, P=0.894).Conclusion Complements C3 and C4 are closely related to essential hypertension.Activation of the complement system is one of the important risk factors for hypertension.The lipid regulating therapy can significantly alleviate immune damage in patients with essential hypertension.Hyperhomocysteinemia is an independent risk factor for essential hypertension.

ObjectiveTo explore the clinical significance of primary suture of common bile duct and early intermittented clamping of T-tube.MethodsOne hundred and one cases underwent bile duct surgery were divided into three group by random digits table,in which 33 cases were performed with primary suture of common bile duct (group A),33 cases were applied of early intermittented clamping of T-tube (group B),the other 35 cases were clamped T-tube as in routine measures (group C).The efficacy was compared between three groups.ResultsThe postoperative intestinal function recovery time,fluid support,hospitalization time in group A and group B was (47.63 ± 12.42) h,(2.75 ± 0.27) L/d,(8.0 ± 0.3) d and (57.63 ± 14.15) h,(2.97 ±0.49) L/d,(10.0 ± 0.4) d,which was significantly decreased compared with those in group C [ ( 98.27 ± 30.35 ) h,( 3.63 ± 0.38 ) L/d,( 19.0 ± 1.1 ) d ] (P ＜ 0.05 ).Postoperative intestinal function recovery in group A was significantly increased compared with those in group B (P ＜ 0.05 ).Alanine aminotransferase,aspartate aminotransferase,Gamma-glutamine transferase,body temperature,white blood cell count,total bilirubin,postoperative biliary fistula,common bile duct residual stones,stenosis of the common bile duct had no significant differences among three groups (P ＞ 0.05). ConclusionsPrimary suture of common bile duct and early intermittented clamping of T-tube can accelerate recovery of intestinal function,avoid electrolyte disturbance,reducing fluids,electrolytes and nutrition support,reducing the length of stay and costs,it has changed the traditional way of surgical treatment of bile duct,and is safe,efficient,also has significance of clinical application.

Objective To investigate the role of dynamic contrast-enhanced MRI (DCE-MRI) in the estimation of tumor angiogenesis and pathologic grading of extrahepatic cholangiocarcinoma.Methods Routine preoperative MRI and DCE-MRI scanning were performed on 57 patients with extrahepatic cholangiocarcinoma.The early signal enhancement ratio (eSER) and delayed signal enhancement ratio (dSER) of DCE-MRI were calculated.Microvessel density (MVD) and vascular endothelial growth factor (VEGF) expressions were detected in the extrahepatic cholangiocarcinoma tissue samples using immunohistochemical methods.The relations between the eSER or dSER and MVD,VEGF and the pathological grading of extrahepatic cholangiocarcinoma were analyzed.Results There was a positive correlation between the eSER or dSER and MVD of extrahepatic cholangiocarcinoma (r =0.62,P ＜ 0.05 ; r =0.45,P ＜ 0.05).The eSER of extrahepatic cholangiocarcinoma with a positive VEGF expression was higher than those with a negative VEGF expression (t =3.53,P ＜ 0.05).There was no significant difference in dSER between the positive VEGF expression group and the negative VEGF expression group (t =1.35,P ＞0.05).There was no significant difference in the eSER or dSER among the different differentiated extrahepatic cholangiocarcinoma (F =2.65,P ＞ 0.05 ; F =2.23,P ＞ 0.05).Conclusions The eSER and dSER reflected tumor angiogenesis of extrahepatic cholangiocarcinoma,and DCE-MRI contributed to the evaluation of biological features of extrahepatic cholangiocarcinoma in vivo.

ObjectiveTo investigate the time characteristics of brain function induced by acupuncture at acupoint of LI4(Hegu).MethodsThe data of functional magnetic resonance imaging(fMRI) induced by acupuncture at acupoint LI4(Hegu) was processed with modified temporal cluster analysis(MTCA) to obtain the time and trend of brain function.ResultsThe stimulation of acupuncture at acupoint LI4 induced the change of brain function,and time curve of brain functional during the acupuncture experiment was obtained.ConclusionThe effect of acupuncture at acupoint LI4(Hegu) on brain function has time characteristics.