A male patient with hypopharyngeal cancer accepted operation under general anesthesia. Sixth day after surgery in patient with sudden chest pain and obvious difficulty in breathing. Blood oxygen saturation of 90%. The electrocardiogram showed: ST-T change,Tv6 flat;blood gas analysis: pH 7. 491, PCO2 34. 1 mmHg, PO2 54. 7 mmHg; D-Dimer 3. 87 mg/L; white blood cell 17. 50 × 10(9)/L. CTPA showed: right pulmonary artery embolism,pulmonary infection. Another male patient with the right tonsil cancer accepted operation under general anesthesia. Fourth day of patient suddenly appear bosom frowsty and obvious difficulty in breathing. Blood oxygen sat- uration of 88%. Blood gas analysis: pH: 7. 48, PCO2 : 33 mmHg, PO2 : 57 mmHg; D-Dimer: 2. 97 mg/L; white blood cell:11. 80 × 10(9)/L. CTPA showed: the main pulmonary artery and right pulmonary artery branch embolism, pulmonary inflammation. Both were diagnosised as acute pulmonary embolism and recovered well after giving anticoagulant therapy in time.
Anesthesia, General ; Electrocardiography ; Fibrin Fibrinogen Degradation Products ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Laryngeal Neoplasms ; surgery ; Male ; Oxygen ; Postoperative Complications ; Pulmonary Embolism

Objectlve To investigate the effects of sevoflurane or ischemic preconditioning on the expression of extracellular signal-regulated kinase (ERK) and calmodulin (CaM) during lung ischemia-reperfusion (I/R)in rats. Methods Twenty-four male SD rats weighing 270-320 g were randomly divided into 4 groups ( n = 6each): sham operation group (group S), group I/R, ischemic preconditioning group (group IP), and sevoflurane preconditioning group (group SP). In group S, the hilum of the left lung was dissociated after thoracotomy but not occluded. In group I/R, lung I/R was produced by occlusion of the hilum of the left lung for 45 min followed by 120 min of reperfusion. In group IP, the hilum of the left lung was occluded for 5 min and unclamped for 5 min for 2 times before the model was established. In group SP, sevoflurane was inhaled for 30 min at the end-tidal concentration of 2.1% before lung ischemia. All rats were sacrificed at 120 min of reperfusion and the lung tissues were taken for determination of the contents of TNF-α and IL-6 by ELISA and the expression of ERK mRNA and CaM mRNA by RT-PCR. Results Compared with group S, the contents of TNF-α and IL-6 and the expression of ERK mRNA and CaM mRNA were significantly increased in group I/R, IP and SP ( P ＜ 0.05). Compared with group I/R, the contents of TNF-α and IL-6 and the CaM mRNA expression were significantly decreased, while the expression of ERK mRNA was significantly increased in group IP and SP ( P ＜ 0.05). There was no significant difference in the each index metioned above between group IP and SP ( P ＞ 0.05 ). Conclusion Sevoflurane preconditioning and ischemic preconditioning can protect the lung from I/R injury through down-regulating the expression of CaM and up-regulating the expression of ERK.

Objective To explore the early diagnostic marker and mechanism of the injury of in- testinal mucosal barrier induced by intestinal ischemia-reperfusion in rats.Methods Sixty male Wistar rats were randomly divided into six groups:the sham operation group(SO),the ischemia 15 minutes group(A),the ischemia 45 minutes group(B),the ischemia 45 minutes plus reperfusion 2 hours group (C),the ischemia 45 minutes plus reperfusion 6 hours group(D),and the ischemia 45 minutes plus reperfusion 12 hours group(E).Using clamping and then releasing superior mesenteric artery the model of intestinal ischemia-reperfusion in rats was made.The sham operation group only underwent laparotomy. At different time points after ischemia and reperfusion the levels of serum CK,LDH,D-lactate and intes- tinal fatty acid binding protein(IFABP)in each group were examined.The morphological changes of in- testinal tissues were observed with light microscopy.Results Compared with group SO,the level of se- rum IFABP in group A was(374.74?48.85)pg/ml,significantly higher(P＜0.01),but the level of CK,LDH and D-lactate had no significant difference(all P＞0.05).In group B,the level of CK was (1090.40?187.51)u/L,peaking at 45 minutes after ischemia,meanwhile,D-lactate and IFABP levels were significantly increased(P＜0.01,respectively).In group C,D-lactate and IFABP were (2.51?0.19)?g/ml and (1601.42?286.81 )pg/ml,respectively,peaking at 2 hours after reperfusion (P＜0.01).At 6 hours after reperfusion,compared with ischemia 45 minutes,CK level was significantly de- creased(P＜0.01),LDH had no significant difference(P＞0.05),but the levels of D-lactate and IF- ABP were(2.03?0.24)?g/ml and(1443.76?174.52)pg/ml,respectively,all sustained a high lev- el(P＜0.01 ).At 12 hours after reperfusion,D-lactate and IFABP levels were gradually decreased(P＜0.01).At 45 minutes after ischemia the morphological changes of intestinal mucosa could be observed. At 6 hours after reperfusion part of the mucous layer appeared necrotic,some intestinal mucosal cells shed to enteric cavity,and submucous layer had hyperemia and edema obviously.Injury scores of intestinal mucosa were significantly correlated to the serum level of D-lactate and IFABP,correlation coefficients were 0.456,0.612(P＜0.01).Conclusion The monitoring of serum IFABP combined with D-lac- tate is a early,sensitive and specific biochemical marker in the diagnosis of intestinal mucosal barrier in- jury after ischemia-reperfusion.

Objective To assess the diagnostic value of texture analysis of MRI in differential dignosis of benign and ma lignant breast nodules.Methods The MRI data of 78 patients (80 breast nodules) identified by surgical pathology were retrospectively studied.Sixty-three texture parameters were obtained from each nodule.ROC curve of texture parameters in differential diagnosis of benign and malignant breast nodules were performed.Results In all of the 63 texture parameters,the run length nonuniformity (RLN) had the highest AUC value (0.836) and accuracy,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value in differentiation of breast nodules were 82.93％ (34/41),94.87％ (37/39),88.75％ (71/80),94.44％ (34/36) and 84.09％ (37/44).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of breast imaging reporting and data system (BIRADS) were 95.12％ (39/41),87.18％ (34/39),91.25％ (73/80),88.63％ (39/44),and 94.44％ (34/36).The difference of diagnostic accuracy between texture parameter and BI-RADS had no statistical significance (P =0.11).BIRADS combined texture parameter improved specificity significantly (P＜0.001).Conclusion The texture analysis could be complementary to improve the accuracy of BI-RADS-MRI in breast nodules.

Objective To evaluate the effects of electroacupuncture (EA) at Zusanli and Chize on sepsisinduced acute lung injury (ALI) in patients.Methods Sixty patients with sepsis-induced ALI/respiratory distress syndrome,aged 43-78 yr,weighing 49-89 kg,with their APACHE-Ⅱ scores of 16-23 and oxygenation index of 125-256 mm Hg,were randomly divided into 3 groups (n =20 each):conventional therapy group (group S),conventional therapy + acupuncture at non-acupoint group (group SNE) and conventional therapy + acupuncture at acupoint group (group SE).Bilateral Huantiao and Chize points were stimulated with electric stimulator (frequency 2/50 Hz,wave length 300μs,starting at a voltage of 0 and increasing by 0.1 mA every time until the maximal tolerance level was reached) for 30 min once a day for 5 days based on the conventional therapy in group SE.In group SNE,EA was performed at the non-acupoint based on the conventional therapy and the parameters of EA were same as those previously mentioned in group SE.Before EA stimulation (T1) and at 3 and 5 days after the end of EA stimulation (T2-3),arterial blood samples were taken for blood gas analysis,oxygenation index (OI) was calculated,and APACHE-Ⅱ] scores were assessed.Venous blood samples were collected at T1 and T3 for detection of TNF-α and IL-10 concentrations in the broncho-alveolar lavage fluid (BALF) and serum (by ELISA).Results Compared with the baseline value at T1,OI was significantly increased and APACHE-Ⅱ scores were decreased at T2 and T3,and TNF-α concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALF and serum were increased at T3 in the three groups (P ＜ 0.05 or 0.01).The OI was significantly higher and APACHE-Ⅱ scores were lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group S,the OI was significantly increased at T2 and T3,APACHE-Ⅱ scores and TNF-α concentrations in the BALF and serum were decreased at T3,and IL-10 concentrations in the BALF and serum were increased at T3 in group SE (P ＜0.05 or 0.01),and no significant changes were found in the parameters mentioned above in group SNE (P ＞0.05).There were no significant differences in the incidence and survival rate of multiple organ dysfunction syndrome among the three groups (P ＞ 0.05).Conclusion EA at Zusanli and Chize is helpful in mitigating sepsisinduced ALI in patients,and regulation of the balance between proinflammatory factors and anti-inflammatory factors and inhibition of inflammatory responses may be involved in the mechanism.

Objective To explore the association between ankylosing spondylitis(AS)with the poly- morphism in -308 site of tumor necrosis factor(TNF)-?promoter region. Methods The literature about AS and polymorphism in -308 site of TNF-?promoter region were searched and the meta analysis as performed. Results Eight studies enrolled 987 AS patients and 922 controls in total. The analysis showed that the fre- quencies of alleles and the genotypes had no statistical difference between AS group and the control group [OR=0.86(0.53, 1.38), P=0.53; OR=0.90(0.52, 1.55), P=0.69]. But the frequencies of alleles of western origin had statistical difference between AS group and the control group [OR=0.75(0.59, 0.96), P=0.02]; The TNF-?gene promoter polymorphism may play a role in the severity of sacroiliitis[OR=0.37(0.15. 0.90), P=0.03]. Conclusion The meta-analysis reveales that the alleles of -308 site of TNF-?promoter region may be associated with AS in western ethnical group and play a role in the severity of saeroiliitis.

Chemoimmunotherapy has attracted much attention as an emerging therapy pattern for the treatment of cancers. Exploring effective drug combination schemes and reasonable delivery methods remained the key issue in current research. Herein, we designed sorafenib (SF) and anti-Tim-3 monoclonal antibody (Tim-3 mAb) co-loaded MMP2-responsive mesoporous silica nanoparticles (ST-MSNs) for combined chemoimmunotherapy of hepatocellular carcinoma (HCC). The shell of ST-MSNs was fabricated by Tim-3 mAb through matrix metalloproteinase 2 (MMP2) sensitive peptides as "gatekeepers" to prevent drug release during the blood circulation. In tumor microenvironment, the high levels of MMP2 caused the responsive shedding of Tim-3 mAb, leading to the triggerred release of SF and Tim-3 mAb. Then, SF could be delivered to tumor cells and Tim-3 mAb could be delivered to T cells, respectively. In vivo tumor inhibition study results demonstrated that ST-MSNs can significantly enhance synergistic antitumor activity compared with sequential administration of free SF solution and Tim-3 mAb solution. Meanwhile, the expression of antitumor cytokines IFN-γ, IL-12 and the percentage of CD3⁺CD4⁺ cells, CD3⁺CD8⁺ cells in tumors were upregulated after the administration of ST-MSNs, demonstrating good immunomodulatory ability. In addition, within the dosage range, the ST-MSNs had low cytotoxicity and hemolysis, and no obvious tissue toxicity was observed. All animal experiments were performed in line with national regulations and approved by the Animal Experiments Ethical Committee of Shandong University. In conclusion, this study provided a promising drug combination of chemoimmunotherapy with good application prospects for clinical HCC treatment, and exhibited a potential drug carrier for clinical chemoimmunotherapy.

Objective To explore the establishment of a rat model of acute radiation-induced liver injury and sig-nificance of the dynamic changes of TGF-β1 expression.Methods Forty healthy 6-week old male SD rats were randomly divided into model group (n=30) and control group (n=10).The right liver of rats in the model group was given a single dose of 25 Gy 6 MV X-ray irradiation.Histopathological examination using HE staining and transmission electron microsco-py were conducted to observe the liver pathological changes in rats at 3, 5, and 10 days after irradiation, serum TGF-β1 was detected, and relevant indicators of liver function ( ALT, AST, ALP) were determined.Statistical analysis was per-formed using SPSS 17.0 software.Results At 3, 5 and 10 days after irradiation, early pathological changes in the liver cells were observed by electron microscopy, the expression of TGF-β1 was gradually increased with the time prolongation, and significant differences were found between the model group and the control group at different time points (P<0.05). The light microscopic observation of liver tissues did not show significant differences between the control group and model group.The liver ALT, AST, ALP at different time points did not show significant differences between the two groups ( P>0.05).Conclusion Electron microscopy can be used to evaluate the early changes of radiation-induced liver injury, pri-or to the alterations visible by routine light microscopy.TGF-β1 can be used to predict the degree of radiation-induced liver injury, and may be used as a sensitive serum cytokine in predicting the degree of radiation-induced acute liver injury.

OBJECTIVETo investigate the clinical value of the mass screening by analyzing the features of prostate cancer between mass screening patients and clinical patients.

METHODSFrom January 2000 to January 2008, 441 cases of prostate cancer (including 122 patients from clinical diagnosis and 319 patients from mass screening 23 183 men who were more than 50 years old) were analyzed from age, digital rectal examination (DRE), serum prostate specific antigen (PSA) levels and range, the Gleason's score and grade, clinical staging and therapy.

RESULTS42.0% of mass screening patients were inspected by DRE, it was lower than that (79.5%) in the clinical patients. The percent of patients with serum PSA levels of less than 10.0 microg/L in mass screening group was higher than in clinical group, while the percent of patients with serum PSA levels of more than 20.0 microg/L in mass screening group was lower than in clinical group. The percent of moderately differentiated degree of prostate cancer in mass screening group was higher than in clinical group, but it was on the contrary for poorly differentiated degree of prostate cancer. The percent of T1-2 prostate cancers in mass screening group was 56.1%, which was higher than 25.4% in clinical group. While, the percent of T3-4 tumors in mass screening group was lower than in clinical group. The percent of men undergoing radical prostatectomy in mass screening group was 18.2%, which was higher than 9.8% in clinical group. The percent of men of locally advanced and far metastasis in mass screening group was 26.0%, while was lower than 46.0% in clinical group.

CONCLUSIONGeneral investigation for prostate cancer is benefit to find asymptomatic cancer of early stage.

Adult ; Aged ; Aged, 80 and over ; Humans ; Male ; Mass Screening ; Middle Aged ; Neoplasm Staging ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; pathology

Objective To evaluate the role of mitochondrial fusion?fission in endotoxin?induced a?cute lung injury in rats. Methods Twenty healthy male Sprague?Dawley rats, weighing 160-180 g, were e?qually and randomly divided into either control group ( group C ) or endotoxin?induced acute lung injury group (group L) using a random number table. Lipopolysaccharide 5 mg∕kg was injected intravenously in group L, while the equal volume of normal saline 0?5 ml was given instead in group C. The animals were sacrificed at 6 h after administration of lipopolysaccharide or normal saline. The lungs were immediately re?moved for measurement of wet to dry lung weight ratio ( W∕D ratio) , superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content. The mitochondrial fusion proteins mitofusin 1 ( Mfn1) , Mfn2 and op?tic atrophy 1 ( OPA1) mRNA and protein expression was detected, and mitochondrial fission proteins dy?namin?related protein 1 (Drp1) and fission 1 (Fis1) mRNA and protein expression was also detected in lung tissues. Results Compared to group C, the W∕D ratio and MDA contents in lung tissues were signifi?cantly increased, SOD activity was decreased, Mfn1, Mfn2 and OPA1 mRNA and protein expression in lung tissues was down?regulated, and Drp1 and Fis1 mRNA and protein expression was up?regulated in group L. The pathological damage to lung tissues was obviously aggravated in group L when compared to group C. Conclusion The mechanism underlying endotoxin?induced acute lung injury is related to enhanced oxidative stress responses caused by decreased mitochondrial fusion and increased mitochondrial fission in rats.