ObjectiveTo investigate the role and its mechanism of the NOD-like receptor 3 (NLRP3) inflammasome in alveolar macrophages in ventilator-induced lung injury (VILI) in rats.Methods Thirty adult male Sprague-Dawley (SD) rats were randomly divided into three groups, with 10 rats in each group: spontaneous breathing control group, normal tidal volume (VT) group (VT 8 mL/kg) and high VT group (VT 40 mL/kg). All of the rats underwent tracheotomy. Then rats in spontaneous breathing control group were kept to have spontaneous breathing, while rats in normal VT group and high VT group received mechanical ventilation. After 4 hours, the rats were sacrificed by carotid artery bleeding, and the bronchoalveolar lavage fluid (BALF), blood serum and lung tissue were collected. Lung wet/dry ratios (W/D) were measured. Light microscopy and electron microscopy were performed to observe the pathological changes in lung tissue, and the ultrastructural changes in alveolar macrophages. Enzyme linked immunosorbent assay (ELISA) was performed to measure the total protein content in the BALF and the interleukins (IL-1β and IL-18) in the serum and BALF. The mRNA expressions and protein levels of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), caspase-1, and nuclear factor-κB (NF-κB) in alveolar macrophages were assayed by real-time fluorescent quantization reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot.Results The structure of lung tissue and alveolar macrophages of rats in spontaneous breathing control group and normal VT group appeared normal, while obvious inflammatory changes were found in high VT group. Compared with spontaneous breathing control group and normal VT group, the ratio of W/D (8.89±0.90 vs. 5.18±0.86, 5.71±0.82, bothP< 0.05), contents of total protein, IL-1β, IL-18 in BALF were significantly increased [total protein (g/L):2.34±0.41 vs. 1.77±0.14, 1.81±0.06, IL-1β (ng/L): 133.48±10.48 vs. 81.54±3.12, 83.80±5.22, IL-18 (μg/L):4.57±0.45 vs. 3.04±0.51, 3.43±0.43, allP< 0.05], and IL-1β and IL-18 in serum were also increased [IL-1β(ng/L): 105.06±10.18 vs. 65.11±8.58, 75.30±10.62, IL-18 (μg/L): 2.27±0.09 vs. 1.18±0.34, 1.43±0.15, all P< 0.05]. The mRNA and protein expressions of NLRP3, ASC, caspase-1 and NF-κB in alveolar macrophages of high VT group were significantly increased compared with that of spontaneous breathing control group and normal VT group. The mRNA expressions of NLRP3, ASC, caspase-1 and NF-κB in high VT group were (8.53±2.21), (5.75±1.17), (7.47±1.23) and (10.86±2.38) folds of those in spontaneous breathing control group, and the protein expressions of NLRP3, ASC, caspase-1 and NF-κB were (1.50±0.14), (1.49±0.04), (1.53±0.15) and (1.51±0.11) folds of those in spontaneous breathing control group (allP< 0.01). There were no significant differences in all the indexes between normal VT group and spontaneous breathing control group.ConclusionNLRP3 inflammasome in alveolar macrophages may be involved in the mechanism of occurrence of VILI.

Objective To analyze clinical data of anorectal malformations(ARM)in children with gastrointes-tinal perforation and explore the features and risk factors associated with gastrointestinal perforation. Methods A retro-spective review was performed in all children with ARM at the Second Affiliated Hospital of Xi′an Jiaotong University from September 2011 to September 2016. The association between gastrointestinal perforations and other factors were statistically analyzed,such as low birth weight,premature birth,delayed diagnosis,and the type of ARM. Based on the related literatures obtained from PubMed,Web of Science and Wanfang database,the clinical characteristics were ex-plored in patients with gastrointestinal perforation complicated with ARM. Results A total of 143 patients with ARM were included in the study,of whom 17 cases belonged to delayed diagnosis,16 cases with low birth weight patients,21 case were premature infants. In all patients,3 patients were complicated with gastrointestinal perforation,and the diagnosis of 2 cases were delayed,2 cases had low birth weight,1 case was premature infant,and the perforation sites were all loca-ted in the sigmoid colon or rectum. Statistical analysis showed that perforation was associated with delayed diagnosis(P =0. 037)and low birth weight(P = 0. 033),however,perforation was not associated with prematurity(P = 0. 381)or the type of ARM(χ2 =0. 000,P =1. 000). A total of 23 cases with complete clinical data in 15 English literatures and 3 cases in the Second Affiliated Hospital of Xi′an Jiaotong University were summarized. The reviewing showed that 92％ of perfo-rations occurred before surgical decompression of the obstructed colon,and 68％ of perforations occurred in the sigmoid colon or rectum. Conclusions Gastrointestinal perforation is a rare complication in ARM. And it is associated with delayed diagnosis,as well as low birth weight or the distal bowel canal underdevelopment. Careful perineal examination will clearly identify the existence of ARM and therefore delayed diagnosis can be totally avoided. Thus,the incidence of bowel perforation in patients with ARM can be reduced effectively.

Objective: To investigate the role and mechanism of Ly6C^high monocyte in mice with ventilator-induced lung injury (VILI). Methods: Forty-eight healthy male SPF C57BL/6 mice were divided into spontaneous breathing group (n = 8), normal tidal volume (VT) group (VT was 8 mL/kg, n = 8), and high VT group (VT was 20 mL/kg, n = 32). The mice in the high VT group were subdivided into 1, 2, 3 and 4 hours subgroups, with 8 mice in each subgroup. All mice underwent direct tracheal intubation, those in the spontaneous breathing group maintained spontaneous breathing, and those in the normal VT group and high VT group were mechanically ventilated with different VT. After ventilation for 4 hours, bronchoalveolar lavage fluid (BALF) was collected to determine total protein, and the levels of inflammatory factors including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by enzyme-linked immune sorbent assay (ELISA). The lung tissues were harvested to determine the wet/dry (W/D) ratio, and lung tissue injury was assessed in terms of lung histopathologic examination after hematoxylin-eosin (HE) staining under the light microscope. The protein expressions of monocyte chemotactic protein-1 (MCP-1) and CC-chemokine receptor 2 (CCR2) in lung tissues were determined by Western Blot. Flow cytometry was used to detect the proportion of Ly6C^high monocyte in lung tissue. Results: The histopathology of lung tissue structures was normal in the spontaneous breathing group and the normal VT group. Inflammatory reaction began to appear at 2 hours of high VT ventilation, and inflammatory reaction was gradually aggravated with the time extension. Compared with the spontaneous breathing group, the total protein, TNF-α, and IL-1β levels in BALF, the lung W/D ratio and MCP-1 expression were increased from 2 hours of high VT ventilation [total protein in BALF (g/L): 1.05±0.13 vs. 0.58±0.11, TNF-α in BALF (ng/L): 116.86±16.14 vs. 38.27±8.00, IL-1β in BALF (ng/L): 178.98±10.41 vs. 117.56±23.40, lung W/D ratio: 5.76±0.27 vs. 4.98±0.39, MCP-1/GAPDH: 0.87±0.19 vs. 0.29±0.12, all P < 0.05], and CCR2 expression and the proportion of Ly6C^high monocyte was significantly increased from 3 hours of high VT ventilation [CCR2/GAPDH: 0.84±0.19 vs. 0.24±0.11, Ly6C^high monocyte proportion: (9.01±2.47)% vs. (1.06±0.35)%, both P < 0.05], and they all showed an increased tendency with the time extension. There was no significant difference in the parameters mentioned above among the spontaneous breathing group, normal VT group and high VT ventilation 1-hour group. Conclusion Ly6C^high monocytes are involved in VILI, which aggravate VILI by activating the MCP-1/CCR2 axis.

OBJECTIVE: To investigate the role and mechanism of Ly6C^high monocyte in mice with ventilator-induced lung injury (VILI). METHODS: Forty-eight healthy male SPF C57BL/6 mice were divided into spontaneous breathing group (n = 8), normal tidal volume (VT) group (VT was 8 mL/kg, n = 8), and high VT group (VT was 20 mL/kg, n = 32). The mice in the high VT group were subdivided into 1, 2, 3 and 4 hours subgroups, with 8 mice in each subgroup. All mice underwent direct tracheal intubation, those in the spontaneous breathing group maintained spontaneous breathing, and those in the normal VT group and high VT group were mechanically ventilated with different VT. After ventilation for 4 hours, bronchoalveolar lavage fluid (BALF) was collected to determine total protein, and the levels of inflammatory factors including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by enzyme-linked immune sorbent assay (ELISA). The lung tissues were harvested to determine the wet/dry (W/D) ratio, and lung tissue injury was assessed in terms of lung histopathologic examination after hematoxylin-eosin (HE) staining under the light microscope. The protein expressions of monocyte chemotactic protein-1 (MCP-1) and CC-chemokine receptor 2 (CCR2) in lung tissues were determined by Western Blot. Flow cytometry was used to detect the proportion of Ly6C^high monocyte in lung tissue. RESULTS: The histopathology of lung tissue structures was normal in the spontaneous breathing group and the normal VT group. Inflammatory reaction began to appear at 2 hours of high VT ventilation, and inflammatory reaction was gradually aggravated with the time extension. Compared with the spontaneous breathing group, the total protein, TNF-α, and IL-1β levels in BALF, the lung W/D ratio and MCP-1 expression were increased from 2 hours of high VT ventilation [total protein in BALF (g/L): 1.05±0.13 vs. 0.58±0.11, TNF-α in BALF (ng/L): 116.86±16.14 vs. 38.27±8.00, IL-1β in BALF (ng/L): 178.98±10.41 vs. 117.56±23.40, lung W/D ratio: 5.76±0.27 vs. 4.98±0.39, MCP-1/GAPDH: 0.87±0.19 vs. 0.29±0.12, all P < 0.05], and CCR2 expression and the proportion of Ly6C^high monocyte was significantly increased from 3 hours of high VT ventilation [CCR2/GAPDH: 0.84±0.19 vs. 0.24±0.11, Ly6C^high monocyte proportion: (9.01±2.47)% vs. (1.06±0.35)%, both P < 0.05], and they all showed an increased tendency with the time extension. There was no significant difference in the parameters mentioned above among the spontaneous breathing group, normal VT group and high VT ventilation 1-hour group. CONCLUSIONS Ly6C^high monocytes are involved in VILI, which aggravate VILI by activating the MCP-1/CCR2 axis.
Animals ; Antigens, Ly/metabolism* ; Lung ; Male ; Mice ; Mice, Inbred C57BL ; Monocytes ; Rats ; Rats, Sprague-Dawley ; Tidal Volume ; Tumor Necrosis Factor-alpha ; Ventilator-Induced Lung Injury

Objective:To evaluate the effectiveness and safety of intravenous infusion of tranexamic acid combined with local infiltration in reducing the perioperative bleeding of prosthetic replacement surgery after massive tumor resection around the knee joint.Methods:Retrospective analysethe patients treated in our hospital from December 2014 to November 2018 underwent tumor resection and prothesis replacement surgery for tumors around the knee, according to whether intravenous infusion of tranexamic acid combined local infiltration of tranexamic acid in the incision was divided into tranexamic acid group and control group. Statistical analysis of postoperative drainage volume, total blood loss, number of blood transfusion, hemoglobin and fibrinogen level in 3 days after surgery, drug-related side effects, wound complications. The differences between the measurement data of the two groups used independent sample t test to compare; the comparison between the count data groups was by χ2 test. Results:In all 116 patients, preoperative intravenous infusion of tranexamic acid combined with intraoperative local infiltration of tranexamic acid in 26 patients, 90 cases in control group; 39 of the replacement required preoperative chemotherapy, There were 8 cases in the tranexamic acid group. In the tranexamic acid group, there were 23 cases (88.46%) in the distal femur and 3 cases (11.54%) in the proximal tibia, and 59 cases (65.56%) in the proximal femur in control group, and 31 cases (34.44%) of the proximal tibia. The length of the osteotomy is similar, the control group is 14.01±3.26 cm, and the tranexamic acid group is 15.21±4.69 cm. The operation time in control group was 2.57 h, and the tranexamic acid group was 2.34 h. Bleeding volume: the bleeding in control group was 613.33±212.76 ml, and the tranexamic acid group was 440.39±208.48 ml ( t=3.636, P=0.002). There were 54 patients (60%) had blood transfusion in control group, and 15 patients (57.69%) in the tranexamic acid group. There was a significant difference between two groups ( χ2=4.771, P=0.029). The total drainage volume was 623.92±316.87 ml in control group, 468.08±220.74 ml in tranexamic acid group ( t=2.328, P=0.022); estimated total blood loss index: 440.47±194.23 ml in control group, tranexamic acid group: 236.75±116.56 ml ( t=5.046, P=0.000); hemoglobin level in 3 d after surgery, control group: 84.29±11.21 g/L, tranexamic acid group: 92.12±13.66 g/L ( t=-2.951, P=0.004), perioperative blood loss: 866.14±418.68 ml in control group, 586.75±409.93 ml in the tranexamic acid group ( t=2.985, P=0.003). There were significant differences between two groups. All patients were rechecked for coagulation function within 3 days after surgery. The PT time of the patients in the tranexamic acid group was 15.01±1.01 s at 3 d, which is 14.88±0.85 s in control group, and the APTT was 41.18±4.61 s in tranexamic acid group, but approximately 40.77±4.63 s in control group, fibrinogen was 3.26±0.66 g/L and 3.31±1.20 g/L in control group, there is no significant difference between two groups. Conclusion:Local infiltration of tranexamic acid intravenous infusion of tranexamic acid during surgery can significantly reduce the perioperative bleeding volume of limb salvage surgery aroundknee joint and reduce allogeneic blood transfusion.

OBJECTIVE： To provide scientific basis for the utilization and development of Miao medicine Oxalis corniculata by promoting the quality standard of it. METHODS： Total of 12 batches of O. corniculata were collected from Guizhou， Anhui and Henan， etc. Microscopic characteristics of 12 batches of O. corniculata powder were observed. According to the corresponding methods in 2015 edition of Chinese Pharmacopoeia （part Ⅳ）， TLC was used for qualitative identification [developing solvent was trichloromethane-methanol-formic acid （8 ∶ 1 ∶ 0.1， V/V/V）]， and the contents of moisture， total ash， acid insoluble ash and alcohol soluble extractive from 12 batches of O. corniculata were determined. The content of isovitexin was determined by HPLC. The determination was performed on Venusil XBP C18 （L） with mobile phase consisted of acetonitrile-0.1％ phosphoric acid solution  （15 ∶ 85， V/V） at the flow rate of 1 mL/min. The column temperature was 35 ℃， and the detection wavelength was set at 338 nm. The sample size was 10 μL. RESULTS： Microscopic observation showed that the powder was grayish brown to yellowish brown， with many non-glandular hairs and obvious fibrous pore. Results of TLC identification showed that the spots of the same color appeared in the corresponding positions of the test and the control chromatogram. The contents of moisture， total ash， acid insoluble ash and alcohol soluble extract from samples were 6.66％-12.13％， 9.16％-13.79％， 1.58％-4.63％ and 5.22％-15.79％， respectively. Results of HPLC method showed that the concentration of isovitexin showed a good linear relationship in the range of 5.20-78.3 μg/mL （r＝0.999 0）； RSDs of reproducibility （n＝9）， intermediate precision （n＝6） and stability （24 h， n＝6） tests were all lower than 2.0％； and the recovery rates were 97.54％-99.52％ （RSD＝0.74％， n＝6）； the contents of isovitexin in 12 batches of O. corniculata were 0.036％-0.144％ （n＝3）. CONCLUSIONS： Qualitative and quantitative identification methods of O. corniculate were established， which can be used as a reference for improving the quality standard of O. corniculata.