Objective To evaluate the effect of sildenafil on the expression of tumor necrosis factor-alpha (TNF-α) in lung tissues of rats with pulmonary hypertension.Methods Twenty-four male Sprague-Dawley rats,aged 8 weeks,weighing 180-220 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),pulmonary hypertension group (group PH),and sildenafil group (group S).Sildenafil 50 mg/kg was injected through a gastric tube into stomach once a day for 35 consecutive days starting from 1 day after lelf pneumonectomy in group S.Pulmonary hypertension was induced by left pneumonectomy and subcutaneous monocrotaline injected at 7 days after operation in PH and S groups.At 35 days after operation,mean pulmonary arterial pressure (mPAP),relative medial thickness of pulmonary artery (RMT),right ventricular systolic pressure (RVSP),and muscularization of small pulmonary arteries were measured in the lung.The ratio of the right ventricular weight to the sum of the weights of the left ventricle and septum (RV/(LV + S)) was calculated.The expression of TNF-α mRNA and protein was determined using RT-PCR and Western blot analysis,respectively.Results Compared with group C,mPAP,RVSP,muscularization of small pulmonary arteries,RMT and RV/(LV + S) ratio were significantly increased,and the expression of TNF-α mRNA and protein was upregulated in group PH,and RVSP,muscularization of small pulmonary arteries and RV/(LV + S) ratio were increased in group S.Compared with group PH,mPAP,RVSP,muscularization of small pulmonary arteries,RMT and RV/(LV + S) ratio were significantly decreased,and the expression of TNF-α mRNA and protein was downregulated in group S.Conclusion Sildenafil can down-regulate the expression of TNF-α in lung tissues of rats with pulmonary hypertension,inhibit reconstruction of pulmonary artery,and decrease the pulmonary arterial pressure.

Humans ; Pancreatic Neoplasms ; surgery ; therapy

Objective To explore the clinical characteristics and influencing factors of primary nephrotic syndrome (PNS) combined with hypercoagulability in children. Methods The clinical data of 57 children with primary PNS were analyzed retrospectively. The clinical features and treatment were compared among high coagulation state group, non high coagulation state group and control group (20 children). At the same time, the differences between the simple nephrotic syndrome group (SNS) and nephritic syndrome group (NNS) in hypercoagulable state were analyzed. In addition, the correlation analysis was performed. Results Among 57 patients, there were 50 patients in high coagulation state group and 7 in non high coagulation state group. There was no significant difference in gender, age and clinical manifestations between two groups (P>0.05). The platelet (PLT) count, platelet aggregation (PCT), albumin (Alb), fibrinogen (Fib), D-dimer (D2) were significantly higher than those in the control group, and there were statistically significant differences (P all<0.01). There were significant differences in the levels of PLT, Fib, D2 and complement C4 between hypercoagulable state group and non hypercoagulable state group (P all<0.05). There were significant differences in HCT, TC, LDL, PT and complement C3 levels between SNS group (n = 32) and NNS group (n =18) in 50 patients with high coagulation state (P<0.05). There was positive correlation between HCT and complement C3 (r=0.30, P<0.05), while there was no correlation between PLT and other indices (P>0.05). All of the 57 patients were improved and has no thrombosis after the treatment. Conclusion Children with primary PNS were usually associated with different degrees of hypercoagulable state, and PLT, Fib, D2 could be used as reference indices for the severity of hypercoagulable state, and the activation of complement system might be related to the occurrence and development of hypercoagulable state.

To explore the relationship and possible mechanism of reproductive function of bisphenol A (BPA) with polycystic ovary syndrome (PCOS).Serum specimens were collected from 43 PCOS patients and 37 healthy women.And the level of BPA was detected by enzyme-linked immunosorbent assay (ELISA).The serum level of BPA in PCOS were significantly higher than that in the control group.And the inter-group difference was significant (P ＜ 0.05).The patient level of BPA was positively related with obesity and basic luteinizing hormone (LH) (P ＜ 0.05).In the PCOS group,no significant correlation existed between hyperandrogenemia and non-hyperandrogenemia (P ＞ 0.05).Although no difference existed between insulin and non-insulin resistance,the level of BPA in insulin resistance group was lower than in non-insulin resistance group.A higher level of BPA may be associated with obesity and basic LH in PCOS.

Adenocarcinoma ; surgery ; therapy ; Combined Modality Therapy ; Humans ; Pancreatic Neoplasms ; surgery ; therapy ; Practice Guidelines as Topic ; Prognosis

The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care pathway, which is to reduce the perioperative stress and metabolic variation, with the ultimate goal of improving patient recovery and outcomes. This article reviews some hot issues in the clinical practice of ERAS in China. Currently, the concept and pathways of ERAS are very consistent with China's medical reform, and the basic principle of "safety first, efficiency second" should be adhered to. In specific clinical practice, multidisciplinary cooperation, the improvement of surgical quality and the implementation of prehabilitation pathway should be advocated. In addition, the ERAS approaches should be implemented individually to avoid mechanical understanding and dogmatic implementation. The implementation of ERAS and its clinical outcome should be audited to accumulate experience, and a feedback mechanism should be established to improve the outcome continuously. In clinical practice, "fast recovery" should not be the sole purpose. For patients, the decrease in the risk of readmission rate is more important as compared to discharge rate. Additionally, the disparities between the development of ERAS clinical research in China and that in the world are also analyzed in this review. A national ERAS database should be established on the basic platform of academic groups to ensure the development of high-quality clinical research in China.
Critical Pathways ; Enhanced Recovery After Surgery ; Humans ; Length of Stay ; Perioperative Care/methods* ; Postoperative Complications

Adolescent ; Brain Diseases ; diagnostic imaging ; Brain Neoplasms ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Hematoma, Epidural, Cranial ; diagnostic imaging ; Hernia ; diagnostic imaging ; Humans ; Male ; Plasmacytoma ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

INTRODUCTIONThe level of participation is an important factor influencing rehabilitation outcome. However, few studies have evaluated rehabilitation participation and its clinical predictors in patients with stroke. This study aimed to establish the level of participation in patients with stroke undergoing inpatient rehabilitation, and define the clinical predictors for participation.

METHODSThis was a prospective observational study of first-time patients with stroke admitted to a rehabilitation centre over a 12-month period. The primary outcome measure was the level of rehabilitation participation as measured on the Pittsburgh Rehabilitation Participation Scale (PRPS). PRPS measurements were made one week after admission and one week before planned discharge from inpatient rehabilitation. Other outcome measures evaluated were the National Institute of Health Stroke Scale, Functional Independence Measure (FIM), Elderly Cognitive Assessment Questionnaire (ECAQ), Centre for Epidemiologic Studies-Depression Scale, Fatigue Severity Scale (FSS), Lubben Social Network Scale-Revised, and Multidimensional Health Questionnaire.

RESULTSA total of 122 patients with stroke were studied. The mean PRPS score on admission was relatively high at 4.30 ± 0.90, and this improved to 4.65 ± 0.79 before planned discharge (p < 0.001). On multivariate analysis, the mean PRPS score on admission was predicted by FIM, EACQ and FSS scores on admission, but not by variables such as age, gender, depression, social support, or health attitudes and beliefs.

CONCLUSIONPatients with lower levels of participation were more likely to be functionally dependent, cognitively impaired and have more fatigue. We suggest that in addition to cognition, fatigue should be routinely screened in patients with stroke undergoing rehabilitation.

Cognition ; physiology ; Disability Evaluation ; Female ; Follow-Up Studies ; Humans ; Incidence ; Inpatients ; Length of Stay ; trends ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; methods ; Patient Compliance ; statistics & numerical data ; Prospective Studies ; Recovery of Function ; physiology ; Rehabilitation Centers ; statistics & numerical data ; Singapore ; epidemiology ; Stroke ; epidemiology ; physiopathology ; Stroke Rehabilitation ; Treatment Outcome

OBJECTIVETo study the effect of total saponins from Entada phaseoloides (TSEP) on islet morphology and skeletal muscle PI3K pathway-related protein expression of type 2 diabetic rats.

METHODType 2 diabetic rats were induced by high-fat diet and low-dose streptozotocin and then randomly divided into 5 groups, i.e. the normal control, the model group, the positive control drug (200 mg x kg(-1) metformin), the low-dose TSEP (25 mg x kg(-1)) group and the high-dose TSEP (50 mg x kg(-1)). Three weeks later, the islet morphology of rat pancreas were observed by HE staining, and protein expressions of insulin receptor substrate-1 (IRS-1), phosphatidylinositol 3-kinase (PI3K), protein tyrosine phosphatase-1B (PTP-1 B) and glucose transporter 4 (GLUT4) in rat skeletal muscle were detected by Western blot.

RESULTCompared with the modal group, TSEP administration groups showed relatively normal structures, clear pancreatic cells and intact capsula structures in pancreatic tissue pathological sections, with the number of pancreatic islets close to the normal control group. Meanwhile, above TSEP administration groups showed increased IRS-1, PI3K and GLUT4 protein expressions in their skeletal muscle tissues and decreased PTP-1B protein expression compared with the model group.

CONCLUSIONTSEP has an effect on protecting pancreatic tissues of type 2 diabetic rats and intervening in abnormal expression of proteins in skeletal muscle tissues.

Animals ; Diabetes Mellitus, Type 2 ; drug therapy ; Fabaceae ; chemistry ; Glucose Transporter Type 4 ; analysis ; Islets of Langerhans ; drug effects ; pathology ; Male ; Muscle, Skeletal ; drug effects ; pathology ; Phosphatidylinositol 3-Kinases ; analysis ; Rats ; Rats, Sprague-Dawley ; Saponins ; therapeutic use

OBJECTIVETo explore the classification, choice of surgical procedures and the clinical outcome of surgical management for chronic pancreatitis.

METHODS54 patients with chronic pancreatitis undergoing operation in our hospital from 1983 to 2004 were analyzed retrospectively, who were divided into chronic calcifying pancreatitis and chronic obstructive pancreatitis according to the clinical manifestations.

RESULTSThere were 41 men (76%) and 13 women (24%) with a mean age of 54 years. The cause of chronic pancreatitis was alcohol related in 25 cases (46%), cholelithiasis in 21 (39%), and previous episodes of acute pancreatitis in 18 (33%). Clinical manifestations included abdominal pain in 38 cases (70%), obstructive jaundice in 27 cases (50%). There existed a significant difference in some clinical materials between the two groups of chronic calcifying pancreatitis and chronic obstructive pancreatitis, which might mean the different pathologic basis in the two kinds of chronic pancreatitis. A total of 34 patients underwent nine different operations without perioperative deaths. Both the Puestow procedure and the pancreatoduodenectomy was safe and achieved pain relief in a large percentage of patients, which could also improve the exocrine function whereas the endocrine function remained unchanged. Addition of biliary bypass to the Puestow procedure was suitable for the patients with stenosis of common bile duct. Jaundice was the main manifestation in the patients with the inflammatory mass in the head of the pancreas and Whipple's procedure or other resectional procedures should be performed for them. Only drainage of bile duct had a better outcome for the relief of jaundice, but its effect to pancreas need to be further evaluated.

CONCLUSIONThe clinicopathologic characteristics of obstructive chronic pancreatitis was more variable and the surgical management should be also different for individuals.

Adolescent ; Adult ; Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Pancreatitis ; classification ; pathology ; surgery ; Retrospective Studies