BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy. METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation (conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy (sequential group) were analyzed retrospectively after appearance of pulmonary infection control (PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia (VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups. RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased. CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.

Reperfusion is the most effective treatment for acute myocardial infarction, markedly reducing mortality and morbidity. Reperfusion however induces necrotic and apoptotic damages to cardiomyocytes, that were viable prior to reperfusion, a process called myocardial ischemia/reperfusion injury(MI/RI). Over the past 30 years, hundreds of experimental interventions (both pharmacologic and nonpharmacologic) have been reported to protect the ischemic myocardium in experimental animals; however, with the exception of early reperfusion, none has been translated into clinical practice. The population-based survey assessed men have about twice the total incidence of morbidity and mortality of women, and the sex gap in morbidity tends to diminish after age 45 years. So hormone replacement therapy (HRT) is given to treat the MI/RI, and lots of studies shows that the side effect is greater for estrogen, compared with phyestrogen. In this article, we review the important pathogenesis of myocardial ischemia reperfusion injury, the prevention and limitations of HRT. And we highlight the mechanism of phyestrogens treatment the MI/RI in experiment. The aim is to provide the theoretically new way of develop the safe and effective products for the researchers.
Animals ; Humans ; Myocardial Ischemia ; drug therapy ; Myocardial Reperfusion Injury ; drug therapy ; Phytoestrogens ; administration & dosage ; Plant Extracts ; administration & dosage

BackgroundWhether the peeling of the inner limiting membrane (ILMP) increase the closure rate of idiopathic macular hole is still in controversy.Some ophthalmologist recommend vitrectomy combined with inner limiting membrane peeling for the treatment of idiopathic macular hole.However,the removal of ILMP is difficult because of its similar appearance to adjacent tissues.Objective This study was to investigate the efficacy of triamcinolone acetonide(TA) and indocyanine green(ICG) double staining-assisted vitrectomy combined with ILM peeling during the surgery.Methods A consecutive case- observational study was designed.The standardized vitrectomy was performed in 25 eye of 23 cases with IMH.During the vitrectomy,TA and ICG were injected into posterior pole vitreous to visualize and assist the ILM peeling.The dying effectiveness was observed,and the closure rate of macular hole,visual acuity,intraocular pressure and complications were evaluated after surgery.Written informed consent was obtained from each patient prior to operation.Results Posterior vitreous cortex and ILM were visible and the residual vitreous and cortex were removed clearly after dying of TA and ICG in all the 25 eyes.During the following-up duration of 3-8 months,the completely anatomical reattachment of the macular area was in 22 eyes ( 88.0％ ) and partially reattachment in 3 eyes( 12.0％ ).The best corrected vision was 0.07-0.60 in all of the operated eyes 2 months after surgery.Conclusions TA and ICG- assisted vitrectomy combined with ILM peeling appears to be a safe and effective method for IMH repair.

The development of laparoscopic total mesorectal excision (TME) has been promoting the better understanding of the anatomy in pre-rectal space for surgeons.If the dissection in pre-rectal space was inappropriate and entered into wrong anatomic planes,it would be easier to cause the proper fascia of rectum incomplete and damage the neurovascular bundies,and reduce the radical surgery outcome and induce urinary and sexual dysfunction,finally,affect the prognosis in patients.For surgical approach in pre-rectal space,the author proposed:Based on the related literatures,transecting the Denonvilliers' fascia (DVF) when it's definitely thickened after cutting the peritoneum 0.5 cm anterior to peri-toneal reflection,entering and dissecting in the space between DVF and the proper fascia of rectum,and forming a typical Three-line feature,including the cutting line of peritoneal reflection,the proximal and distal cutting lines of DVF,which can serve as the mark line and mark plane of the entrance to pre-rectal space.Not only this approach can keep the proper completeness of rectal fascia,but also it maximally reserves the DVF.Here,this article discussed the embryonic origins and anatomic characters of DVF,the structures of neurovascular bundles,dissection in the pre-rectal space,surgical approach and clinical outcomes between DVF and laparoscopic TME.

Objective To develop a liquid bandage for self aid of war wound.Methods Solution A and B were prepared containing functional polymers derived from the biocompatible poly (ethylene glycol) and hyaluronic acid,which had ability of fast crosslinking reaction when they were mixed.Among them,A solution mainly comprised of mercapto group-containing hyaluronic acid derivative (HA-SH),water-solubility starch,propylene glycol,benzoic acid and etc.B solution contained pentaerythritol tetraacrylate derivative (4arm-PEG-Acrylate) and benzoic acid.The structure of mercapto group-containing hyaluronic acid derivative was confirmed by IR,1H-NMR and etc.HA-SH and 4arm-PEG-Acrylate were formulated to different concentrations (W/V) in different buffers.The two kinds of solution were mixed in different ratios,and in situ crosslinking hyaluronic acid hydrogel was obtained;the crosslinking time was recorded.The adhesive force and waterholding capacity of the hydrogel after crosslinking were measured by adding excipients such as water-solubility starch.Results In case the concentration of HA-SH and 4arm-PEG-Acrylate was 2％ and pH value was 11,the hydrogel film on wound skin would be quickly formed in 20 seconds for wound dressing after spraying A and B solution onto the wound skin.Conclusion The liquid bandage has strong adhesive force,high water-holding capacity and controllable crosslinking time,so it could be used as a novel wound dressing for war wound.

Objective To explore the impact and protective mechanisms of head cooling on neural activity during passive hyperthermia.Methods Sixteen subjects were randomly exposed for 1 h to three different conditions: normal (25℃), hot (50℃) and head cooling (chamber:50℃,cold packs:5℃),after environment exposure, rs-fMRI were performed.Regional homogeneity(ReHo) datum at three different conditions were analyzed by REST2.0 to obtain brain areas with statistical difference.Brain voxel with statistical difference were selected as ROIs to ReHo values and were analyzed by One-Way ANOVA with SPSS18.0.Neural activity of brain areas with statistical difference were compared in any two groups by Post hoc.Results The brain regions showing differences among three groups included right orbital frontal cortex,left middle frontal gyrus,bilateral amygdala,left middle temporal gyrus,left hippocampus,bilateral parietal inferior, left precentral gyrus.Compared with normal group, ReHo increased in right orbital frontal cortex, and decreased in left precentral gyrus,left middle frontal gyrus,left parietal inferior,but no changed in bilateral amygdala,left middle temporal gyrus,left hippocampus,right parietal inferior in head cooling group.Compared with hot group,head cooling group showed increased ReHo in left middle temporal gyrus,left hippocampus,right parietal inferior,and decreased ReHo in bilateral amygdala,left parietal inferior,unchanged ReHo in right orbital frontal cortex, left precentral gyrus, left middle frontal gyrus.Conclusion The specified alterations of ReHo may reflect that the head cooling could partially eliminate the impact of passive hyperthermia, and is closely linked with emotional function.

Adult ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Female ; Humans ; Keratin-5 ; metabolism ; Lymph Node Excision ; Lymphatic Metastasis ; Mastectomy, Radical ; methods ; Middle Aged ; Transcription Factors ; metabolism ; Tumor Suppressor Proteins ; metabolism

Objective To investigate the effects of CO_2 pneumoperitoneum on the expression of focal adhesion kinase (FAK) of gastric cancer MKN-45 cells. Methods CO_2 pneumoperitoneum with different pressures was simulated in vitro, and the gastric cancer MKN-45 cells were divided into test and control groups. In the test group, gastric cancer MKN-45 cells were cultured in CO_2 pneumoperitoneum with different pressures [5, 10 or 15 mm Hg (1 mm Hg =0.133 kPa)] for 4 hours. The condition of the cells exposed to CO_2 pneumoperitoneum with a pressure of 15 mm Hg was observed at 0.5, 2 and 4 hours. Gastric cancer MKN-45 cells in control group were cultured at normal atmospheric pressure. The expression of FAK and phosphorylated FAK (FAK Tyr397) of each group was detected by Western blot. Multiple-group analysis was done by one-way ANOVA, and intergroup comparison was done by LSD test. Results In CO_2 pneumoperitoneum with pressures of 5, 10, 15 mm Hg, the expression of FAK was 2.14±0.17, 2.07±0.21 and 2.52±0.26, respectively, and the expression of FAK Tyr397 was 1.82±0.28, 1.93±0.52 and 3.71±0.37, respectively. The expression of FAK and FAK Tyr397 in the control group was 2.43±0.46 and 1.71±0.23, respectively. We found significant differences between the 2 groups (F = 2.171, 26.951, P < 0.01). After gastric cancer MKN-45 cells being treated for 0.5, 2 and 4 hours in CO_2 pneumoperitoneum with a pressure of 15 mm Hg, the expression of FAK Tyr397 was 3.41±0.44, 4.12±0.56 and 5.24±0.41 respectively, which is also significantly different (F =116.119, P < 0.01). The expression of FAK Tyr397 was back to 0.72±0.16 1 hour after the release of CO_2. Conclusions CO_2 pneumoperitoneum with different pressures can not promote the expression of FAK in gastric cancer MKN-45 cells which had been cultured for 4 hours, but can activate FAK through promoting its phosphorylation. The degree of FAK phosphorylation increases with pressure and time, and the activity of FAK decreases to pretreatment level rapidly once pressure is released.

Objective To investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.

Objective To investigate the alterations of Treg cells , Th17 cells and related cyto-kines in peripheral blood of patients during the early stage of hand-foot-mouth disease ( HFMD) .Methods Flow cytometry was performed to analyze the percentages of Treg cells ( CD4+CD25+Foxp3 T cells) and Th17 cells ( CD3+CD8-IL-17+T cells) in peripheral blood samples collected from 49 patients with severe HFMD , 26 patients with common HFMD and 30 healthy children.The levels of IL-6, IL-10, IL-17, IL-23 and TGF-β1 in serum samples were measured by ELISA .Results The percentages of Treg cells , ratios of Treg/Th17 cells, serum levels of TGF-β1 and IL-10 in patients with HFMD were significantly decreased as compared with those of control group (F=5.580, 6.205, 0.000, 0.014, respectively, P<0.05).Patients with se-vere HFMD showed a significantly increased Th17 cells (F=3.189 P<0.05) and a tendency of enhanced IL-17 expression , but no significant differences with the levels of IL-17 were observed .No significant differ-ences with the expression of IL-23 in the patients among each group were detected (P>0.05).The levels of IL-6 in serum samples from severe disease group were obviously increased as compared with those of common HFMD group and control group (F=7.318, P<0.05).Conclusion The results of this study demonstrated that the levels of Treg , Th17 cells and some related cytokines were varied in peripheral blood of patients dur-ing the early stage of HFMD .Inflammatory responses were enhanced to promote anti-virus activities by sup-pressing Treg cells and stimulating Th17 cells.