Objective: To study the etiology, clinical manifestation, diagnosis, treatment and precaution of pulmonary embolism following major surgery of gastrointestinal malignant tumors. Methods: Thirty-two cases of pulmonary embolism following major surgery of gastrointestinal malignant tumors were analyzed retrospectively. Results: The most common clinical manifestations were dyspnea, thoracodynia and palpitation. The D-dimer of all cases was positive. The examination of pulmonary arteriography by spiral computed tomography might assist the diagnosis of the disease. Twenty-two patients were discharged through the treatment of oxygen therapy and anticoagulation. Six patients recovered through the treatment of assisted respiration by respirator, thrombolysis and anticoagulation. Four patients died of respiratory failure. Conclusion: The operation of gastrointestinal malignant tumors can increase the incidence of pulmonary embolism. Arteriography by spiral computed tomography and D-dimer can assist the diagnosis and thrombolysis and anticoagulation were effectivel for the treatment.

The aim of this study was to develop the data element standard directory of traditional Chinese medicine (TCM) clinical pharmacy information, to provide application standards and models of TCM clinical pharmacy for the electronic medical record (EMR). The developed line of work is as follows: initially establish research through four forms: literature analysis, questionnaires, discussion groups, expert advice. The research range from the Chinese herbal medicine research, herbal origin, harvesting, processing, identification of traits, physical and chemical identification, modern research, character, taste, Indications, clinical application, processing, dispensing medicine, Chinese medicine specifications, usage, dosage, caution, efficacy indications to small packaging applications, drug research, management and other related issues, including traditional Chinese medicine theory, application and hospital management information; according to the general and part 16 content of the national "Health Information Data Element Standards", and the basic method of extracting data element to study and develop the data element of TCM clinical pharmacy information from the defining content. Correspondingly propose the ideas and methods of construction of the "Data Element Standard Directory of TCM Clinical Pharmacy Information", sort out medicine clinical information data element standard catalog, divided into basic categories, clinical application class, management class three parts, and set norms and standards of identifying data elements, definitions, allowable value of traditional Chinese medicine clinical information, and discuss the sources and standards of information collection, leaving the interface, standardized and scientific terminology, docking with the existing standards, maintenance and management program and oter issues.
China ; Data Mining ; methods ; statistics & numerical data ; Database Management Systems ; standards ; statistics & numerical data ; Electronic Health Records ; standards ; statistics & numerical data ; Evidence-Based Medicine ; methods ; statistics & numerical data ; Humans ; Information Dissemination ; methods ; Medicine, Chinese Traditional ; methods ; Phytotherapy ; methods ; statistics & numerical data

BACKGROUND: In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising (PLR) mimics an endogenous volume expansion (VE) that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index (SVI) induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. METHODS: This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position (baseline) and during PLR by the technique of pulse indicator continuous cardiac output (PiCCO) system prior to VE. Measurements were repeated after VE (500 mL 6％ hydroxyethyl starch infusion within 30 minutes) to classify patients as either volume responders or non-responders based on their changes in stroke volume index (ΔSVI) over 15％. Heart rate (HR), systolic artery blood pressure (ABPs), diastolic artery blood pressure (ABPd), mean arterial blood pressure (ABPm), mean central venous pressure (CVPm) and cardiac index (CI) were compared between the two groups. The changes of ABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ΔSVI and the change of CVPm (ΔCVPm) in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. RESULTS: Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables (including ABPs, ABPd, ABPm and CVPm) were significantly elevated (101.2±17.6 vs.118.6±23.7,P=0.03; 52.8±10.7 vs. 64.8±10.7,P=0.006; 68.3±11.7 vs. 81.9±14.4,P=0.008; 6.8±3.2 vs. 11.9±4.0,P=0.001). After PLR, the area under curve (AUC) and the ROC curve of ΔSVI and ΔCVPm for predicting the responsiveness after VE were 0.882±0.061 (95％CI 0.759–1.000) and 0.805±0.079 (95％CI 0.650–0.959) when the cut-off levels of ΔSVI and ΔCVPm were 8.8％ and 12.7％, the sensitivities were 72.7％ and 72.7％, and the specificities were 80％ and 80％. CONCLUSION: Changes in ΔSVI and ΔCVPm induced by PLR are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.

Background:Cold storage and ischemia-reperfusion injury of liver grafts are critical for the prognosis of patients undergoing liver transplantation. Establishing a stable cold storage and reperfusion animal model is a fundamental measure for related studies. Aims:To establish a modified isolated perfused rat liver model for comprehensive assessment of liver grafts in studies on preservation of liver grafts before transplantation. Methods:Twelve Sprague-Dawley rats were randomly allocated into two groups. Livers of rats in control group were retrieved and perfused immediately for 90 minutes without preservation. In experimental group,liver grafts underwent a 30-minute warm ischemia followed by 24-hour cold storage before ex vivo perfusion. The perfusate was collected dynamically for monitoring the levels of transaminases,electrolytes and pH value;the portal vein pressure of liver grafts was measured by pressure sensor,and the hepatic hydrogen peroxide (HPO)level was assessed by microprobe for free radicals. The bile production was recorded after the ex vivo perfusion;meanwhile,the levels of malondialdehyde (MDA)and superoxide dismutase (Cu/ Zn SOD),the histopathological changes and apoptosis of hepatocytes of liver grafts were examined. Results:Compared with the control group,the levels of AST and ALT,the portal vein pressure and the HPO level of liver grafts in experimental group were obviously increased throughout the perfusion. Furthermore,the bile production and level of Cu/ Zn SOD of liver grafts in experimental group were significantly decreased. The histopathological injury and hepatocytes apoptosis of liver grafts were milder in control group. Conclusions:The liver function and antioxidant effect were reduced in warm ischemic and cold preserved liver grafts. The modified isolated perfused rat liver model established in this study is useful for monitoring and evaluation of the cold storage and reperfusion injury in liver grafts.

Objective To investigate the value of diffusion kurtosis imaging (DKI) in differential diagnosis of parotid gland disease and diagnosis of parotid adenolymphoma (PAL).Methods DKI and DWI data of 57 patients with parotid gland disease were etrospectively analyzed.Totally 57 cases were divided into infectious lesions group (n=10),pleomorphic adenoma group (n=19),PAL group (n=14),other benign parotid tumor group (n=4) and malignant parotid tumor group (n=10).Contralateral normal parotid glands in 19 patients with unilateral parotid gland lesions were treated as control group.The quantitative parameters including kurtosis concerning parameters (K Krad,Kax),diffusivity concerning parameters (D Drad,Dax),fractional anisotropy (FA) and conventional apparent diffusion coefficient (ADC) values were retrospectively reviewed.The binary Logistic regression method was used to confirm parameters with significant difference in diagnosing PAL.And Logistic regression equation was constructed to diagnose PAL.ROC analysis was conducted to evaluate the diagnostic value of the confirmed parameters and the Logistic regression equation.Results Significant difference of the parameters including K Krad,Kax,D Drad,Dax,FA and ADC values were found among different groups (all P＜0.05).ROC analysis demonstrated a higher area under the curve (AUC) for FA+Kax [0.88±0.06 (0.79-0.94)] than Kax[0.80±0.07 (0.70-0.88)] and FA [0.63±0.10 (0.52-0.73)],respectively (both P＜0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 71.43％,95.78％,91.77％,76.92％ and 94.44％.Conclusion DKI showed high diagnostic capacity in differential diagnosis of parotid gland disease.The combination of FA and Kaxcan improve the diagnostic accuracy in diagnosis of PAL.

Objective To evaluate the safety and clinical efficacy of system thrombolysis combined with percutaneous catheter thrombus fragmentation and thrombectomy for acute massive pulmonary embolism. Methods Ninteen patients with acute massive pulmonary embolism were treated with IVC filter placement, percutaneous catheter thrombus fragmentation and system thrombolysis combined with anticoangulation using low-molecular-weight heparin.Four of 19 patients underwent adjuvant Stranb Rotarex catheter thrombectomy.Results Twenty-one procedures were performed in 19 patients.Improvement of pulmonary artery patency and initial relief of symptoms immediately occurred in 18 of 19 patients after interventional therapy.The oxygen saturation increased from 86% to 97%.Pulmonary artery pressure decreased from 33? 5mm Hg(1mm Hg=0.133kPa)to 25?5mmHg after interventional therapy(t=13.2,P

To observe the effect of electro-acupuncture on matrix metalloproteinase in degenerated cervical intervertebral disc rats.Methods:The rat model of cervical intervertebral disc degeneration was induced by unbalanced dynamic and static forces,then the rats were randomly allocated to model group,electro-acupuncture groupⅠ(acupoints Dazhu(BL 11) and Tianzhu(BL 10) were electro-acupunctured),and electro-acupuncture group Ⅱ(acupoints Dazhu (BL 11),Tianzhu(BL 10)and Shenshu(BL 23) were electro-acupunctured),with the normal rats as control.then the HE staining method was adopted to observe the morphological change of cervical intervertebral disc and the immunohistochemical staining method was used to detect the marx metalloproteinases-1(MMP-1) and matrix metalloproteinases-3(MMP-3) in cervical intervertebral disc.Results:The morphological observation showed that after electro-acupuncture treatment,the degrees of cervical intervertebral disc degeneration in electro-acupuncture groupⅠand electro-acupuncture group Ⅱ were alleviated,and the electro-acupuncture group Ⅱ was superior to electro-acupuncture group Ⅰ.The expressions of MMP-1 and MMP-3 in degenerated cervical intervertebral disc were increased(P＜0.01),and after electro-acupuncture treatment,the expressions of MMP-1 and MMP-3 in degenerated cervical intervertebral disc were decreased,especially the electro-acupuncture group Ⅱpresented the better effect as compared with electro-acupuncture group Ⅰ(P＜0.05).Conclusions:Electro-acupuncture at acupoints Dazhu (BL 11) and Tianzhu (BL 10) had a certain therapeutic effect on cervical intervertebral disc degeneration,and in combination with acupoint Shenshu(BL 23),this therapeutic effect could be enhanced,its action mechanism might be that electro-acupuncture can reduce the expressions of MMP-l and MMP-3 in degenerated cervical intervertebral disc,inhibit the degradation of matrix in intervertebral disc.so as to relieve cervical intervertebral disc degeneration.

OBJECTIVETo explore the protective effect of recombinant beta-defensin-2 (BD2) on acute lung injury induced by sepsis in rats.

METHODSRecombinant adenovirus carrying an expression cassette of rat BD2 (rBD2) or control adenovirus carrying empty vector was administered intratracheally to Sprague-Dawley rats 48 h before acute lung injury, which was induced by cecal ligation and double puncture (CLP). Histological changes of the lungs and 7-day survival rate were determined.

RESULTThe alveolar damage, interstitial edema, and infiltration of neutrophils were reduced and the survival rate was increased significantly in BD2 group than those in control group (P < 0.05). The CFU of abdominal bacteria was comparable to that in the control rats (P > 0.05).

CONCLUSIONThe administration of recombinant BD2 protects lung injury and improves the survival of rats with induced sepsis.

Acute Disease ; Adenoviridae ; genetics ; Animals ; Genetic Therapy ; methods ; Genetic Vectors ; Lung Diseases ; etiology ; therapy ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Recombinant Fusion Proteins ; genetics ; physiology ; Sepsis ; complications ; Survival Analysis ; beta-Defensins ; genetics ; physiology

OBJECTIVETo explore the possibility of stable expression of cationic peptide beta-defensin-2 in eukaryocytes with adenovirus vector.

METHODSThe rat beta-defensin-2 (rBD2) gene was cloned at the downstream of CMV promoter of the adenoviral shuttle plasmid pShuttle-CMV. Then pShuttle-CMV-rBD2 was transformed into E. coli BJ5183-AD-1, in which recombination occurred between plasmids and pAdEasy-1 to construct pAdEasy-rBD2. After confirmation by endonuclease, linear pAdEasy-rBD2 was transformed into 292 cells to obtain packaged adenoviral expression vector, which was used to infect cos-7 cells and to establish respiratory adenovirus infection model of rat. The in vivo and in vitro expression activity of recombinant adenovirus was detected by Western blot and immunohistochemistry.

RESULTThe inserted DNA of pShuttle-CMV-rBD2 consisted of rat beta-defensin-2 gene. The pathological effect of infected cells, electronic microscopic observation and PCR showed that the recombinant adenovirus vector was constructed successfully. The concentration of the adenovirus was 10(9) PFU/ml. The vector expressed rat beta-defensin-2 efficiently in vivo and in vitro.

CONCLUSIONThe recombinant adenovirus vector can express cationic peptide beta-defensin-2 in eukaryocytes.

Adenoviridae ; genetics ; Animals ; Blotting, Western ; COS Cells ; Cell Line ; Cercopithecus aethiops ; Eukaryotic Cells ; metabolism ; Gene Expression ; Genetic Vectors ; genetics ; Humans ; Immunohistochemistry ; Male ; Rats ; Rats, Sprague-Dawley ; Recombinant Fusion Proteins ; genetics ; metabolism ; beta-Defensins ; genetics ; metabolism

Objective To determine the affinities of five oligopeptides specifically binding with DNA binding domain of NF-?B p65 subunit and identify their inhibiting effect on DNA binding activity of NF-?B. Methods By using biosensor the affinities were measured by means of kinetic analysis, and the inhibiting effects were determined by competitive ELISA. Results The results of biosensor showed that all of five oligopeptides really possessed the capability of specific interacting with NF-?B p65 subunit. The affinity constants of these oligopeptides were 2.67?10~ -7 mol/L, 9.02?10~ -6 mol/L, 1.07?10~ -6 mol/L, 8.03?10~ -6 mol/L, 9.83?10~ -7 mol/L respectively. The results of competitive ELISA indicated that five oligopeptides could inhibit NF-?B from binding with ?B motif, and their inhibiting effect depended on their concentration. Conclusion Five oligopeptides that were screened by yeast two-hybrid system method can really interact with p65, and possess the inhibiting effect on DNA binding activity of NF-?B. So it will be possible that these oligopeptides are regarded as model to design and develop novel anti-inflammatory peptide drug targeting NF-?B.